Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated?

Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians' acceptance of the COVID-19 vaccine and its associated factors.

METHODS

A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.

RESULTS

In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.

CONCLUSION

Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.

Differences in COVID-19 Vaccine Acceptance, Hesitancy, and Confidence between Healthcare Workers and the General Population in Japan

Little is known about the differences in coronavirus disease (COVID-19) vaccine acceptance and hesitancy between the general population and healthcare workers in Japan. To compare these differences, a nationwide web-based cross-sectional survey was conducted on 19 January 2021, shortly before the initiation of COVID-19 vaccinations in Japan. A total of 6180 men and women aged 20-69 years and 1030 healthcare workers aged 20-69 years were enrolled. Data on COVID-19 vaccine acceptance, basic characteristics, including socioeconomic factors, and confidence in immunization in general were collected. COVID-19 vaccine acceptance was also evaluated under hypothetical vaccine effectiveness and adverse event frequencies. Factors associated with vaccine hesitancy were examined using multinomial logistic regression analysis. The COVID-19 vaccine acceptance rate was 48.6% among the general population and was lower among nurses (45.5%) and medical clerks (40.7%). Women and young adults had significantly higher COVID-19 vaccine hesitancy odds ratios, and current smokers had significantly lower odds ratios. The frequency of adverse events was a COVID-19 vaccine hesitancy factor. Even if these factors were adjusted, COVID-19 vaccine hesitancy among nurses was 1.4 times higher than that among the general population. Thus, interventions to improve health literacy and vaccine hesitancy among the general population and healthcare workers, especially nurses, are needed.

Science, healthcare system, and government effectiveness perception and COVID-19 vaccination acceptance and hesitancy in a global sample: an analytical cross-sectional analysis

BACKGROUND

Determinants of COVID-19 vaccine acceptance are complex; how perceptions of the effectiveness of science, healthcare and government impact personal COVID-19 vaccine acceptance is unclear, despite all three domains providing critical roles in development, funding and provision, and distribution of COVID-19 vaccine.

OBJECTIVE

To estimate impact of perception of science, healthcare systems, and government along with sociodemographic, psychosocial, and cultural characteristics on vaccine acceptance.

DESIGN

We conducted a global nested analytical cross-sectional study of how the perceptions of healthcare, government and science systems have impacted COVID-19 on vaccine acceptance.

SETTING

Global Facebook, Instagram and Amazon Mechanical Turk (mTurk) users from 173 countries.

PARTICIPANTS

7411 people aged 18 years or over, and able to read English, Spanish, Italian, or French.

MEASUREMENTS

We used Χ2 analysis and logistic regression-derived adjusted Odds Ratios (aORs) and 95% CIs to evaluate the relationship between effectiveness perceptions and vaccine acceptance controlling for other factors. We used natural language processing and thematic analysis to analyse the role of vaccine-related narratives in open-ended explanations of effectiveness.

RESULTS

After controlling for confounding, attitude toward science was a strong predictor of vaccine acceptance, more so than other attitudes, demographic, psychosocial or COVID-19-related variables (aOR: 2.1; 95% CI: 1.8 to 2.5). The rationale for science effectiveness was dominated by vaccine narratives, which were uncommon in other domains.

LIMITATIONS

This study did not include participants from countries where Facebook and Amazon mTurk are not available, and vaccine acceptance reflected intention rather than actual behaviour.

CONCLUSIONS

As our findings show, vaccine-related issues dominate public perception of science's impact around COVID-19, and this perception of science relates strongly to the decision to obtain vaccination once available.

COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

Knowledge and attitudes toward vaccination among nurses and midwives in Cyprus: A cross-sectional study

PURPOSE

To assess the level of knowledge and attitudes of nurses and midwives in Cyprus toward vaccinations and provide new insights into the determinants that influence them.

METHODS

An online cross-sectional study was carried out during the period between December 08 and 28 2020. Participants included registered nurses and midwives working in public or private service provision. A self-administered questionnaire was used with questions about sociodemographic characteristics, questions assessing attitudes and beliefs toward vaccination, and participants' general vaccine knowledge.

FINDINGS

A total of 437 responders answered the survey, with 93% being nurses and 7% midwives. Around two-thirds (67.3%) of the participants had a high vaccination knowledge, while the remaining have moderate (30.7%), and low (2.1%), respectively. Most of the participants agreed that by vaccinating they protect themselves and those around them (80.5%) and that when most people are not vaccinated, epidemics can easily initiate (74%). Oppositely, many participants disagreed with vaccination and avoided it due to a fear of injections (95.4%) or the belief that it is better to get sick rather than be vaccinated (69.1%). Neutral attitudes toward vaccine-mediated side effects (43.1%) and vaccination safety (41.7%) were observed. Sociodemographic factors such as age, educational status, and work setting significantly affected the nurses' and midwives' knowledge and attitudes toward vaccination (p < 0.05).

CONCLUSIONS

The findings indicate that the overall vaccination knowledge of participants was high, however, gaps in vaccination knowledge were observed. Individuals who adopted a neutral stance toward vaccination can be prone to changes either toward positive or negative attitudes.

IMPLICATIONS FOR NURSING PRACTICE

The survey findings suggest implementing educational strategies and targeted interventions in clinical settings to enhance nurses' and midwives' vaccination knowledge and awareness.

Regional Differences in COVID-19 Vaccine Hesitancy in December 2020: A Natural Experiment in the French Working-Age Population

It can be assumed that higher SARS-CoV-2 infection risk is associated with higher COVID-19 vaccination intentions, although evidence is scarce. In this large and representative survey of 6007 adults aged 18-64 years and residing in France, 8.1% (95% CI, 7.5-8.8) reported a prior SARS-CoV-2 infection in December 2020, with regional variations according to an East-West gradient (p < 0.0001). In participants without prior SARS-CoV-2 infection, COVID-19 vaccine hesitancy was substantial, including 41.3% (95% CI, 39.8-42.8) outright refusal of COVID-19 vaccination. Taking into account five characteristics of the first approved vaccines (efficacy, duration of immunity, safety, country of the vaccine manufacturer, and place of administration) as well as the initial setting of the mass vaccination campaign in France, COVID-19 vaccine acceptance would reach 43.6% (95% CI, 43.0-44.1) at best among working-age adults without prior SARS-CoV-2 infection. COVID-19 vaccine acceptance was primarily driven by vaccine characteristics, sociodemographic and attitudinal factors. Considering the region of residency as a proxy of the likelihood of getting infected, our study findings do not support the assumption that SARS-CoV-2 infection risk is associated with COVID-19 vaccine acceptance.

COVID-19 Vaccine Hesitancy and Attitude toward Booster Doses among US Healthcare Workers

Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18–40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required; however, vaccine-hesitant respondents’ acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported; the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination.

Willingness to Vaccinate Against COVID-19: Predictors of Vaccine Uptake Among Adults in the US

The uptake of the COVID-19 vaccine will determine the trajectory for improved population health and economic recovery from the COVID-19 pandemic. Identifying factors associated with vaccine acceptance is imperative as public health officials strategize to improve uptake. In this study, we identified predictors of vaccine willingness and acceptance using univariate logistic regression to model predictors and calculate odds ratios. Participants (N = 946) who reported greater vaccine willingness were male, older, and had a higher level of education and income. Behaviors indicative of reducing the spread of COVID-19 (e.g., testing) and perceived risk of COVID-19 infection were associated with vaccine willingness, as were participants who believed they were “highly likely” to be infected (by a factor of 8). Education tailored to demographic groups with low vaccine uptake should focus on the high degree of communicability associated with COVID-19. Implementing mobile healthcare screenings could remove barriers to healthcare, thereby improving health equity.

A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

Evaluation of the United States COVID-19 vaccine allocation strategy

BACKGROUND

Anticipating an initial shortage of vaccines for COVID-19, the Centers for Disease Control (CDC) in the United States developed priority vaccine allocations for specific demographic groups in the population. This study evaluates the performance of the CDC vaccine allocation strategy with respect to multiple potentially competing vaccination goals (minimizing mortality, cases, infections, and years of life lost (YLL)), under the same framework as the CDC allocation: four priority vaccination groups and population demographics stratified by age, comorbidities, occupation and living condition (congested or non-congested).

METHODS AND FINDINGS

We developed a compartmental disease model that incorporates key elements of the current pandemic including age-varying susceptibility to infection, age-varying clinical fraction, an active case-count dependent social distancing level, and time-varying infectivity (accounting for the emergence of more infectious virus strains). The CDC allocation strategy is compared to all other possibly optimal allocations that stagger vaccine roll-out in up to four phases (17.5 million strategies). The CDC allocation strategy performed well in all vaccination goals but never optimally. Under the developed model, the CDC allocation deviated from the optimal allocations by small amounts, with 0.19% more deaths, 4.0% more cases, 4.07% more infections, and 0.97% higher YLL, than the respective optimal strategies. The CDC decision to not prioritize the vaccination of individuals under the age of 16 was optimal, as was the prioritization of health-care workers and other essential workers over non-essential workers. Finally, a higher prioritization of individuals with comorbidities in all age groups improved outcomes compared to the CDC allocation.

CONCLUSION

The developed approach can be used to inform the design of future vaccine allocation strategies in the United States, or adapted for use by other countries seeking to optimize the effectiveness of their vaccine allocation strategies.

Understanding Drivers of Coronavirus Disease 2019 Vaccine Hesitancy Among Blacks

BACKGROUND

Coronavirus disease 2019 (COVID-19) has disproportionately affected communities of color, with black persons experiencing the highest rates of disease severity and mortality. A vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to reduce the race mortality gap from COVID-19; however, hesitancy toward the vaccine in the black community threatens vaccine uptake.

METHODS

We conducted focus groups with black barbershop and salon owners living in zip codes of elevated COVID-19 prevalence to assess their attitudes, beliefs, and norms around a COVID-19 vaccine. We used a modified grounded theory approach to analyze the transcripts.

RESULTS

We completed 4 focus groups (N = 24 participants) in July and August 2020. Participants were an average age of 46 years, and 89% were black non-Hispanic. Hesitancy against the COVID-19 vaccine was high due to mistrust in the medical establishment, concerns with the accelerated timeline for vaccine development, limited data on short- and long-term side effects, and the political environment promoting racial injustice. Some participants were willing to consider the vaccine once the safety profile is robust and reassuring. Receiving a recommendation to take the vaccine from a trusted healthcare provider served as a facilitator. Health beliefs identified were similar to concerns around other vaccines and included the fear of getting the infection with vaccination and preferring to improve one's baseline physical health through alternative therapies.

CONCLUSIONS

We found that hesitancy of receiving the COVID-19 vaccine was high; however, provider recommendation and transparency around the safety profile might help reduce this hesitancy.

Acceptance of the COVID-19 Vaccine by Foreigners in South Korea

Vaccination against COVID-19 is an important strategy for its control. Assessing the willingness to accept the COVID-19 vaccine in different subgroups is important for an inclusive vaccination program design. Our aim was to determine the COVID-19 vaccine acceptance rate and associated factors among foreigners in South Korea. An online cross-sectional study was carried out from May to June 2021. In this study, 710 individuals participated and most were aged between 26 and 29 (36.1%) years. Overall, 70.8% were willing to receive the vaccine. Males were less likely to accept the vaccine than females (OR: 0.5; 95% CI: 0.4–0.7, p < 0.001). Single people were more likely to receive the vaccine than those who were married (OR: 1.4; 95% CI: 0.9–2.0, p = 0.04). Other factors associated with willingness to accept COVID-19 vaccine were; vaccine convenience (OR: 1.7; 95% CI: 1.2–2.3, p = 0.002), doctors’ recommendation (OR: 2.8; 95% CI: 2.0–3.9, p < 0.001), vaccine price (OR: 1.7; 95% CI: 1.2–2.3, p = 0.003), vaccine effectiveness (OR: 8.3; 95% CI: 5.8–12.1, p < 0.001), vaccine importance (OR: 7.9; 95% CI: 4.6–14.1, p < 0.001), and vaccine safety (OR: 6.9; 95% CI: 4.5–10.8, p < 0.001). Providing more information on vaccine safety and effectiveness is required to increase vaccine acceptance.

Willingness to Vaccinate against Coronavirus Disease 2019 and Related Predictors among Non-Healthcare Personnel in Indonesia

BACKGROUND: Herd immunity against COVID-19 can be realized when a minimum of 62% of the vulnerable population has been vaccinated. However, achieving uptake of recommended vaccination in the targeted population ultimately lies with the community's willingness. Vaccine skepticism varies across demographic characteristics and stems from the perceived threats of being infected with COVID-19 while receiving the vaccine. AIM: This research was intended to determine the willingness to vaccinate against COVID-19 and its associated factors. METHODS: It employed a cross-sectional, then the collected data were analyzed using descriptive analytics: difference test and relationship analysis. Study with two online surveys on Google Forms and non-healthcare personnel as the research subjects. Screening with inclusion and exclusion criteria yielded 862 respondents spread over 32 provinces in Indonesia Results: showed no difference in COVID-19 knowledge scores in surveys 1 and 2 (76.0‒77.2; p=0.08). Age and education level are significantly related to COVID-19 knowledge scores (p<0.05). About 42.4% of respondents in survey 1 and 55.6% in survey 2 were willing to receive the vaccine, with 36.8‒45.3% feeling hesitant. The main reason for vaccine hesitancy (42.2%) and unwillingness (43.2%) was mistrust in the effects or benefits of the vaccine. Although demographic characteristics are not related to the willingness (p>0.05), the opposite is true for the COVID-19 knowledge level [OR:1.66; 95% CI:1.26–2.18]. Conclusion about half of the non-healthcare personnel (42.4‒55.6%) are willing to receive the vaccine, with knowledge of the disease being a predictor (p=0.00).

The Paradox of Conspiracy Theory: The Positive Impact of Beliefs in Conspiracy Theories on Preventive Actions and Vaccination Intentions during the COVID-19 Pandemic

This study aims to analyze the direct and indirect impact of beliefs in conspiracy theories on COVID-19-related preventive actions and vaccination intentions. The dominant theory in the literature is that beliefs in conspiracy theories have negative consequences. In particular, strong beliefs in conspiracy theories lower people’s intentions to engage in preventive actions and get vaccinated. Previous studies indicated that this dominant theory applies in Korea as well. However, we find that this dominant theory does not apply in Korea. Based on an analysis of survey data, we find that beliefs in conspiracy theories have positive impact on preventive actions and vaccination intentions. In addition, beliefs in conspiracy theories play indirect roles in these two responses to COVID-19. Specifically, when perceived benefits and trust in the government or science enhance preventive actions or increase vaccination intentions, strong beliefs in conspiracy theories promote this effect. This positive role of conspiracy theories is paradoxical because they are generally viewed as negative.

Anti-COVID Vaccination for Adolescents: A Survey on Determinants of Vaccine Parental Hesitancy

Vaccine hesitancy has been considered one of the most severe threats to global health, as it represents an obstacle to achieving adequate vaccination coverage. Recent research studies aimed at investigating the propensity for anti-COVID vaccination among adults have found a high prevalence of vaccine hesitancy, but few data are available on parental vaccine hesitancy. We therefore built an anonymous online survey to investigate the factors related to the vaccine hesitancy of parents of adolescents between 12 and 17 years of age, with a special focus on demographic factors and the domains of confidence and complacency. The online survey was conducted by using the Crowd Signal platform from 15 July to 16 August 2021, in Italy. A total of 1799 analyzable questionnaires were analyzed. Overall, Favorable and Doubtful parents declared a higher level of confidence on safety and efficacy of pediatric vaccines and on confidence in health institutions than Hesitant/Reluctant ones (p-values < 0.001). The univariate multinomial logistic regression analysis and the multivariate multinomial logistic regression analysis showed that the Hesitant/Reluctant parents were younger than 40 years of age, with a secondary-school or three-year degree, free-lance, with a family income below €28,000, with an erroneous perception of the risk of COVID-19 as disease and with fear of anti-COVID vaccination. These results, which should be confirmed in a larger population and in different geographical areas, should lead Institutions and stakeholders to identify targeted communication tools to improve trust in health institutions, especially by younger parents.

COVID-19 Vaccine Hesitancy and Acceptance among Medical Students: An Online Cross-sectional Study in Iraq

BACKGROUND: Vaccine hesitancy and reluctant had an important obstacle in achieving protection and population immunity against coronavirus disease 19 (COVID-19). It is essential to achieve high COVID-19 vaccination acceptance rates among medical students and health care workers to provide recommendations and counseling vaccine hesitant population. AIM: This study aims to identify level of COVID-19 hesitancy, attitude, knowledge, and factors that affect vaccination decision. MATERIALS AND METHODS: A cross-sectional study was done among medical students in Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq. Data collection was done through an online Google Forms questionnaire during 2021 from 810 medical students. RESULTS: A total of 810 adults’ medical students participated in this study. The majority of the study participants were female (488, 60.2%) while males were 322, 39.8%. Vaccine concept hesitancy among males was 65.21% and rest were vaccinated (34.78%) (OR = 0.13) (95% CI = 0.096–0.177) (p = 0.0001). Same hesitancy from COVID-19 vaccine was same with females (66.80%). CONCLUSIONS: This study evaluated and shed light on vaccine hesitancy among sample of Iraqi medical students toward COVID-19 vaccination program and considered medical students as leaders and guides in the health system for increased planning and education of the population for COVID-19 vaccine acceptability.

Acceptance of a COVID-19 Vaccine Before it is Available in China During the Pandemic

Objectives: China was believed to be the country with the world’s highest acceptance rate of the COVID-19 vaccine following several investigations. This study aims to explore the Chinese acceptance of a COVID-19 vaccine before it is made available, including its determinants.

Methods: A cross-national online survey was conducted covering all 31 provinces of mainland China. The survey consists of the demographic variables, acceptance of a self-paid COVID-19 vaccine as the dependent variable, and the 3Cs factors (i.e., confidence, convenience, and complacency) as the independent variables.

Results: Among the 1,532 participants, 57.9% accepted to get a self-paid COVID-19 vaccine. COVID-19 vaccine acceptors were more likely to be concerned about the effectiveness of the vaccines, believe that they were at risk of COVID-19 infection, have a high perceived susceptibility of COVID-19, and trust in the health care system.

Conclusion: Findings indicate that the critical task in the early stage of the COVID-19 vaccine development in China is to increase the tolerance to some intuitive concerns about the vaccines, put more emphasis on the communication of the saliency of the disease threats, and effectively translate people’s trust in the government into vaccine acceptance.

Attitudes of Medical Students toward COVID-19 Vaccination: Who Is Willing to Receive a Third Dose of the Vaccine?

Medical students may come in contact with individuals infected with COVID-19 in their clinical rotations. A high level of acceptance of vaccination is needed for them to protect their health and the health of patients from this disease. The objectives of this study were to (1) obtain information on medical students' attitudes toward COVID-19 vaccination, (2) assess factors associated with students' attitudes, and (3) identify predictors of their willingness to receive a third dose of the COVID-19 vaccine. Using a cross-sectional design, we conducted a questionnaire survey of medical students in July 2021. For this survey, we employed a 15-item questionnaire specifically developed to assess the students' attitudes toward COVID-19 vaccination. Of the 742 distributed questionnaires, 496 (294 males and 202 females) were completed. Among all the participants, 89.1% (442/496) received the second dose of the vaccine, and 90.7% (450/496) indicated that they would hypothetically receive the COVID-19 vaccine in the future. Furthermore, 84.5% (419/496) of all the participants were willing to receive a third dose of the vaccine. Regarding willingness to receive a third dose of the COVID-19 vaccine, multiple logistic regression models showed that students' grade and their responses to Q1 (positive attitude toward vaccination), Q9 (belief in the protection offered by COVID-19 vaccination), Q10 (concern about the excessively rapid development of COVID-19 vaccines), Q12 (need for aspects of pre-pandemic life), and Q14 (concern about the sustainability of immunity) had significant associations with this outcome. Confidence in vaccines, relaxation of mobility restrictions, and concern about the sustainability of immunity motivate willingness to receive a third dose of the COVID-19 vaccine in medical students.

Perceptions of the COVID-19 vaccine among patients with cancer: a single-institution survey

Aims: This paper reports the results of a survey assessing the acceptance of the COVID-19 vaccine among patients with cancer. Patients and methods: In total, 111 adult patients with cancer from a single institution were asked to complete a questionnaire designed to assess their knowledge about the vaccine, their readiness to be vaccinated and the determinants of their decision. Results: 61.3% of the patients considered themselves more vulnerable to COVID-19 than the general population. Television, radio and newspapers were the major sources of information about the vaccine. A total of 55% of the patients were ready to be vaccinated and 14.4% refused the vaccine. The main reason for refusal was incompatibility with patients' disease or treatment. Conclusion: Most of the patients in this institutional sample accepted the COVID-19 vaccine. Better communication of information with patients is needed to decrease vaccine hesitancy.

Trends in COVID-19 vaccination intent from pre- to post-COVID-19 vaccine distribution and their associations with the 5C psychological antecedents of vaccination by sex and age in Japan

Vaccine hesitancy regarding the coronavirus disease 2019 (COVID-19) vaccine is widespread during the COVID-19 pandemic. Many recent studies have reported that the confidence of the vaccination and perceived risk were associated with vaccination intent, yet few studies have focused on other psychological factors. This study aimed to clarify the trends in COVID-19 vaccination intent and to identify the association between the 5C psychological antecedents and COVID-19 vaccination intent by sex and age in Japan. This was a longitudinal study conducted through an Internet-based survey from January 2021 to April 2021 before and after vaccine distribution in Japan, including 2,655 participants recruited by quota sampling. Participants were asked to indicate how likely they were to get vaccinated against COVID-19. In the second survey, the participants responded to questions regarding the 5C psychological antecedents: confidence, complacency, constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and collective responsibility (willingness to protect others). Multiple logistic regression analysis was performed to clarify the association between the 5C psychological antecedents and COVID-19 vaccination intent in the second wave survey. COVID-19 vaccination intent improved from 62.1% to 72.4% after vaccine distribution, but no significant difference was found in young men. Confidence and collective responsibility were positively associated with vaccination intent, and calculation was negatively associated among all generations. COVID-19 vaccination intent may be affected not only by confidence and constraints but also by calculation and collective responsibility, and further research is needed.

COVID-19 vaccine hesitancy in underserved communities of North Carolina

BACKGROUND

In the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina.

METHODS

We conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 -December 15, 2020. Vaccine hesitancy was defined as the response of "no" or "don't know/not sure" to whether the participant would get the COVID-19 vaccine as soon as it became available.

RESULTS

The sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]).

CONCLUSIONS

This study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.

Attitudes and Intentions of US Veterans Regarding COVID-19 Vaccination

Importance

Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines.

Objective

To assess veterans' attitudes toward and intentions to receive COVID-19 vaccines.

Design, Setting, and Participants

This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients' Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021.

Exposures

Veterans eligible for COVID-19 vaccines.

Main Outcomes and Measures

The outcomes of interest were veterans' experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes.

Results

Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 141 (12%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ24 = 5.90; P = .21) or gender (χ22 = 3.99; P = .14).

Conclusions and Relevance

These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one's own health.

Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors

OBJECTIVE

Older people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors.

METHODS

We conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged ≥60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021.

RESULTS

In total, we interviewed 282 participants aged 60-93 years (mean age 73.0±7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system's ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day.

CONCLUSION

The prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand's senior citizens.

Factors influencing COVID-19 vaccination intention among overseas and domestic Chinese university students: a cross-sectional survey

To vaccinate the Chinese on a nationwide scale timely and effectively, it is necessary to assess the vaccination uptake intention of the public. University students are opinion leaders, who have an important impact on the vaccination uptake intention of others around them. As a group with strong population mobility, overseas university students have an extra influence on the spread of COVID-19 and the prevention and control of the pandemic. Thus, it is necessary to investigate the vaccination uptake intention of overseas and domestic university students to promote vaccination and control the pandemic globally. However, little is known about the COVID-19 vaccination uptake intention among overseas and domestic university students. This study aimed to explore the difference between overseas and domestic Chinese university students' COVID-19 vaccination uptake intentions and influencing factors using the Health Belief Model. A cross-sectional survey using an online questionnaire was conducted among 370 overseas university students and 463 domestic university students between January and February 2021. More than half of the respondents (536, 64.3%) reported vaccination uptake intentions, with overseas and domestic university students reporting similar vaccination uptake intentions (64.1% vs 64.6%, p > .05). Perceived benefits, perceived barriers, and cues to action were important factors that influenced the vaccination intention among overseas and domestic university students. It is worth trying to communicate the benefits of the vaccine, enhance the role of cues to action, and eliminate the potential barriers among overseas and domestic university students through creative propagation to further promote the COVID-19 vaccination.

The mediational role of trust in the healthcare system in the association between generalized trust and willingness to get COVID-19 vaccination in Iran

For some individuals, there appears to be some level of unwillingness in getting a COVID-19 vaccine which may be due to trust issues. The present study used a mediation model to investigate how trust is associated with an individual’s willingness to get COVID-19 vaccination among Iranians. A total of 10,843 Iranian adults were recruited in Qazvin province using a multistage stratified cluster sampling method. The survey was completed between February 19 and April 9, 2021. The findings showed that generalized trust was positively associated with trust in the healthcare system, trust in the healthcare system was positively associated with willingness to get COVID-19 vaccination, and generalized trust was positively associated with willingness to get COVID-19 vaccination. Also, trust in the healthcare system mediated the association between generalized trust and willingness to get COVID-19 vaccination. There were some significant demographic differences in COVID-19 vaccination willingness. The findings suggest that generalized trust plays a significant role in directly or indirectly influencing individuals’ willingness to get COVID-19 vaccine. Therefore, government bodies and health officials may utilize these findings to appeal in a more transparent and professional manner in encouraging individuals to get a COVID-19 vaccine. However, for those with lower trust levels (in general and in the healthcare system), the focus may be to re-build and/or regain the individuals’ trust through carefully planned transparent communication, information dissemination, and ethical education to help increase the uptake of COVID-19 vaccination.

Sars-CoV2 vaccine hesitancy in Italy: A survey on subjects with diabetes

BACKGROUND AND AIMS

Vaccine Hesitancy (VH) is a relevant obstacle for the COVID-19 vaccination campaign. The aim of this study is to assess the proportion of subjects unwilling to vaccinate among patients with type 1 (T1DM) and 2 (T2DM) diabetes, exploring factors associated with VH.

METHODS AND RESULTS

A purposely created interview was delivered from physicians to a consecutive series of adult (>18 years) subjects with diabetes referring to the Diabetes Outpatient Clinic of Careggi Hospital, Florence, from January 1st to April 30th 2021. Out of 502 subjects enrolled, 92 were vaccine hesitant respondents (18.3%); the corresponding figure for T1DM and T2DM was 13.0% (N = 14), and 19.9% (N = 78), respectively. After adjusting for age, higher HbA1c (1.07 [1.02-1.13], p = 0.008) and triglycerides levels (1.03 [1.01-1.06], p = 0.011) were positively associated with VH, among patients with T1DM. At multivariate analysis, after adjusting for age, creatinine, and statin use, patients with T2DM affected by obesity (9.98 [4.89-9.59], p < 0.01) and with lower levels of creatinine (0.36 [0.21-0.54], p = 0.029) were more likely to refuse COVID vaccination.

CONCLUSIONS

Hesitancy toward COVID-19 vaccination among subjects with diabetes is not negligible and seems to be more prevalent in individuals with lower adherence to medical prescriptions and/or reduced concerns over their health. This suggests the need for specific interventions to increase awareness and counter prejudices on vaccines.

A Scoping Review to Find Out Worldwide COVID-19 Vaccine Hesitancy and Its Underlying Determinants

BACKGROUND

The current crisis created by the coronavirus pandemic is impacting all facets of life. Coronavirus vaccines have been developed to prevent coronavirus infection and fight the pandemic. Since vaccines might be the only way to prevent and stop the spread of coronavirus. The World Health Organization (WHO) has already approved several vaccines, and many countries have started vaccinating people. Misperceptions about vaccines persist despite the evidence of vaccine safety and efficacy.

OBJECTIVES

To explore the scientific literature and find the determinants for worldwide COVID-19 vaccine hesitancy as reported in the literature.

METHODS

PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed to conduct a scoping review of literature on COVID-19 vaccine hesitancy and willingness to vaccinate. Several databases (e.g., MEDLINE, EMBASE, and Google Scholar) were searched to find relevant articles. Intervention- (i.e., COVID-19 vaccine) and outcome- (i.e., hesitancy) related terms were used to search in these databases. The search was conducted on 22 February 2021. Both forward and backward reference lists were checked to find further studies. Three reviewers worked independently to select articles and extract data from selected literature. Studies that used a quantitative survey to measure COVID-19 vaccine hesitancy and acceptance were included in this review. The extracted data were synthesized following the narrative approach and results were represented graphically with appropriate figures and tables.

RESULTS

82 studies were included in this scoping review of 882 identified from our search. Sometimes, several studies had been performed in the same country, and it was observed that vaccine hesitancy was high earlier and decreased over time with the hope of vaccine efficacy. People in different countries had varying percentages of vaccine uptake (28-86.1%), vaccine hesitancy (10-57.8%), vaccine refusal (0-24%). The most common determinants affecting vaccination intention include vaccine efficacy, vaccine side effects, mistrust in healthcare, religious beliefs, and trust in information sources. Additionally, vaccination intentions are influenced by demographic factors such as age, gender, education, and region.

CONCLUSIONS

The underlying factors of vaccine hesitancy are complex and context-specific, varying across time and socio-demographic variables. Vaccine hesitancy can also be influenced by other factors such as health inequalities, socioeconomic disadvantages, systemic racism, and level of exposure to misinformation online, with some factors being more dominant in certain countries than others. Therefore, strategies tailored to cultures and socio-psychological factors need to be developed to reduce vaccine hesitancy and aid informed decision-making.

Community acceptance and willingness to pay for hypothetical COVID-19 vaccines in a developing country: a web-based nationwide study in Nigeria

INTRODUCTION

some promising COVID-19 vaccines are soon to be available but getting the African community to accept them may be challenging. This study assessed the acceptability and willingness to pay (WTP) for hypothetical COVID-19 vaccines among Nigerians.

METHODS

a cross-sectional, web-based study was conducted among the Nigerian populace. A 20-item questionnaire was used to collect responses through Google form which was shared to consenting participants through two social media platforms. Multivariate logistic regression was used to determine the sociodemographic factors that were predictive of respondents´ willingness to accept the COVID-19 vaccines. Statistical significance was set at p<0.05.

RESULTS

six hundred and eighty-nine respondents completed the survey, with 50.5% being females. Exactly 43.3% of respondents reported that they would accept a hypothetical vaccine if it is currently available, 62.1% said they would accept it in the future while 71.1% agreed to accept it if recommended by healthcare providers. A third (31.9%) of respondents accepted the vaccine for their self-protection and half of those not accepting it (51.3%) said they did not want to "be used as an experiment". Respondents who were of oldest ages (aOR=0.330, 95% CI: 0.141-0.767, p=0.010), of Christian religion (aOR=3.251, 95% CI: 1.301-8.093, p=0.011), and aware of a possible vaccine being made available (aOR=0.636, 95% CI: 0.440-0.920) were significantly more unwilling to accept the vaccine. The median range of WTP was US$1.2-2.5.

CONCLUSION

there is a low acceptance in Nigeria for a COVID-19 vaccine if it was available now, but much higher if it is recommended by a healthcare provider. A high proportion of willing respondents indicated a positive WTP for the vaccine.

Prediction Model for COVID-19 Vaccination Intention among the Mobile Population in China: Validation and Stability

Since China’s launch of the COVID-19 vaccination, the situation of the public, especially the mobile population, has not been optimistic. We investigated 782 factory workers for whether they would get a COVID-19 vaccine within the next 6 months. The participants were divided into a training set and a testing set for external validation conformed to a ratio of 3:1 with R software. The variables were screened by the Lead Absolute Shrinkage and Selection Operator (LASSO) regression analysis. Then, the prediction model, including important variables, used a multivariate logistic regression analysis and presented as a nomogram. The Receiver Operating Characteristic (ROC) curve, Kolmogorov–Smirnov (K-S) test, Lift test and Population Stability Index (PSI) were performed to test the validity and stability of the model and summarize the validation results. Only 45.54% of the participants had vaccination intentions, while 339 (43.35%) were unsure. Four of the 16 screened variables—self-efficacy, risk perception, perceived support and capability—were included in the prediction model. The results indicated that the model has a high predictive power and is highly stable. The government should be in the leading position, and the whole society should be mobilized and also make full use of peer education during vaccination initiatives.

Perception and attitude towards COVID-19 vaccination: A preliminary online survey from India

Context:

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic taking more than 1.7 million lives. While many developed countries are starting their vaccination drive, India is not far behind but still not much is known about the willingness to get a vaccination in India.

Aims:

To find out the perception and attitude toward vaccination against COVID-19 among the adult population of India in order to know the proportion of people who are willing to get vaccinated against COVID-19.

Method:

A cross-sectional study was conducted between October 26, 2020 and November 10, 2020. Data were collected online using a self-administered and semi-structured questionnaire among adults aged 18 years or more in India via web-based links. The minimum sample size was calculated by considering the proportion of willingness to take the vaccination as 50%, 95% confidence interval, and 5% alpha error—the calculated sample size was 384. However, 467 participants completed the survey during the study period. Data were analyzed using SPSS version 21.

Results:

A total of 467 participants responded, out of which 329 (70.44%) showed a willingness to get vaccinated and 138 (29.55%) were hesitant to get vaccinated against COVID-19. Only 49.4% believed that people can be protected by the vaccine; 63.1% of the people were willing to get their children vaccinated; and 59.31% felt the vaccine should be free for all.

Conclusions:

The pan India survey conducted online revealed that approximately 3 in 10 adults were not willing to get vaccinated against COVID-19. This can guide policymakers to make multipronged efforts to increase the willingness to get a vaccination against COVID-19.

Acceptability of COVID-19 vaccine: a cross-sectional study in a Tunisian general hospital

Introduction

the year 2020 was marked by the COVID-19 pandemic that killed more than one million people. Several vaccines have been developed and vaccination campaigns started in December 2020. The objective of our study was to assess the acceptability of the COVID-19 vaccine by hospital staff.

Methods

cross-sectional study conducted on a representative sample drawn at random from the staff of the Military General Hospital of Tunis. Data was collected between August and September 2020 by a clinical psychologist. We studied the associations between the different characteristics of our population and the decision to accept or refuse vaccination against COVID-19.

Results

a total of 398 hospital staff agreed to answer our questionnaire. Our sample was composed of 9% (n=36) physicians, 0.9% (n=3) pharmacists, 41.3% (n=164) paramedics, 16.1% (n=64) cleaning staff and 32.7% (n=131) administrative staff. The rapid discovery of the vaccine was hoped by 97% (n=386). Vaccination was considered a means of collective protection by 84.7% (n=337). However, only 58% (n=231) agreed to be vaccinated by the COVID-19 vaccine. The main factors significantly associated with acceptance of the COVID-19 vaccine was previous influenza vaccination (aOR: 2.58, 95% CI 1.69-3.94; p=0.000).

Conclusion

apprehension about vaccination does not appear to be sparing the future COVID-19 vaccine. Fear of vaccine side effects outweighs fear of the disease, even among hospital staff. To achieve vaccination coverage, several awareness and communication activities must be carried out.

The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses

COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

Background

Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh.

Methods

An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18–65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations.

Results

The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.

Conclusions

The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11880-9.

The behavioral immune system and vaccination intentions during the coronavirus pandemic

The behavioral immune system is considered to be a psychological adaptation that decreases the risk of infection. Research suggests that, in the current environment, this system can produce attitudes with negative health consequences, such as increased vaccine hesitancy. In three studies, we investigated whether two facets of the behavioral immune system-germ aversion (i.e., aversion to potential pathogen transmission) and perceived infectability (i.e., perceived susceptibility to disease)-predicted intentions to accept COVID-19 and influenza vaccination during the pandemic. The behavioral immune system mechanisms were measured before the COVID-19 pandemic in one study, and during the pandemic in two. In contrast to previous research, those with higher germ aversion during the pandemic perceived vaccines to be safer and had higher intentions to accept vaccination. Germ aversion before the pandemic was not associated with vaccination intentions. Individuals who perceived themselves as more susceptible to disease were slightly more willing to accept vaccination. We conjecture that high disease threat reverses the relationship between the behavioral immune system response and vaccination. As the associations were weak, individual differences in germ aversion and perceived infectability are of little practical relevance for vaccine uptake.

COVID-19 Vaccine Hesitancy Among Patients With Epilepsy or Other Chronic Conditions

Objectives:

The aim of this study was to investigate the opinions of different groups of people in Iran on their willingness to receive a coronavirus disease 2019 (COVID-19) vaccine.

Methods:

In this cross-sectional study, we surveyed a sample (based on consecutive referrals) of 5 groups of people in late 2020: a group of the general population from Shiraz (without a history of any chronic medical or psychiatric problems), patients with epilepsy, patients with diabetes mellitus (DM), patients with cardiac problems, and patients with psychiatric problems. The survey included 4 general questions and 3 COVID-19–specific questions.

Results:

A total of 582 people participated. In total, 66 (11.3%) people expressed that they were not willing to receive a COVID-19 vaccine. Psychiatric disorders (odds ratio [OR]: 3.15; 95% confidence interval [CI]: 1.31-7.60; P = 0.006) and male sex (OR: 2.10; 95% CI: 1.23-3.58; P = 0.010) were significantly associated with COVID-19 vaccine hesitancy.

Conclusion:

Vaccine hesitancy is a global issue. Patients with psychiatric disorders had the highest rate of vaccine hesitancy. Previous studies have shown that depression and anxiety are associated with a reduced adherence to the recommended medical advice. Why male sex is associated with vaccine hesitancy is not clear. Researchers should investigate the rates and the factors affecting the vaccine hesitancy in their corresponding communities.

Predictors of COVID-19 Vaccination Campaign Success: Lessons Learnt from the Pandemic So Far. A Case Study from Poland

The high effectiveness of a vaccination-promotion campaign, which may be measured by the number of those successfully convinced to get vaccinated, is a key factor in combating the COVID-19 pandemic. This, however, appears to be linked to the precise identification of the underlying causes for vaccine hesitancy behaviours. Based on a regression model (adjusted R² of 0.78) analysing 378 sub-regions of Poland, we showed that such behaviours, even when going against the party agenda, can be indirectly yet precisely gauged predominantly through voting patterns. Additionally, education and population density were found to be positively related to low vaccine hesitancy, while markers of social exclusion, both external (employment rate) and psychological (voter turnout) ones, affected it negatively. In the second, follow-up part of our study, which analyses the changes that took place in two months (adjusted R² of 0.53), we found a further increase in vaccination rate to be positively related to the number of those already vaccinated and to the political views of the population, and negatively related to its level of education. In both cases, there was a surprisingly weak relationship between the potential markers of accessibility and vaccination rate. In spite of the known overall differences in vaccination rates for different age and sex groups, these variables did not have any additional informative value in explaining the observed regional differences.

Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey

Since health professionals provide frontline care to COVID-19 patients, information on vaccine acceptance among healthcare workers is needed. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbach’s alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy, and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. The appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates amongst healthcare workers.

Sociodemographic and Behavioral Predictors of COVID-19 Vaccine Hesitancy in Pakistan

BACKGROUND

The current coronavirus disease 2019 (COVID-19) pandemic continues with resurgent second and third waves worldwide. Vaccination is one of several measures that are needed to end this pervasive threat. Pakistan, however, has a relatively low rate of routine vaccine acceptance. Our study aimed to determine the proportion and predictors of COVID-19 vaccine hesitancy (VH) among adults in Pakistan.

METHODS

An online cross-sectional study was conducted from December 27, 2020 to March 6, 2021. Non-probability sampling was applied to recruit study participants through social media platforms (ie, Facebook and Twitter) and through free messaging services (WhatsApp). Stata 16 was used to generate descriptive statistics and logistic regression models for identifying predictive variables of vaccine hesitancy. A p-value of <0.05 was considered strong evidence against the null hypothesis.

RESULTS

Out of 1014 participants, 35.8% (n=363) were hesitant about receiving the COVID-19 vaccine. Reasons for VH included concerns about side effects (42.4%), belief in conspiracy theories (20.1%), perceived inefficacy of the vaccine (13.2%), and perceived protection through precautionary measures (12.6%). Urban residency (AOR 2.34, 95% CI 1.54-3.57), reservations about vaccine safety (AOR 3.29, 95% CI 1.68-6.44), uncertainty about vaccine efficacy (AOR 2.70, 95% CI 1.50-4.86), failure of the vaccine to reduce hospitalization and death (AOR 6.36, 95% CI 4.01-10.22), and unfelt need for vaccination awareness among public (AOR 2.02, 95% CI 1.28-3.14) were associated with higher rates of VH. At least one chronic disease (AOR 0.60, 95% CI 0.39-0.92), knowing someone infected with COVID-19 (AOR 0.56, 95% CI 0.39-0.81), and trusting information from the ministry of health (AOR 0.64, 95% CI 0.41-0.99) and physicians (AOR 0.27, 95% CI 0.13-0.53) were found to be associated with lower rates of COVID-19 VH.

CONCLUSION

More than one third of survey participants were VH. COVID-19 vaccine uptake in Pakistan can be improved through targeted health education strategies and planned interventions that address the barriers identified in the present study.

COVID-19 vaccine hesitancy concerns: Findings from a Ghana clinical radiography workforce survey

Introduction

Vaccination is a key global strategy to mitigate the clinical impact of the COVID-19 virus. As part of local efforts to manage the outbreak, the government of Ghana announced its intention to vaccinate its population starting with essential and high-risk workers including radiographers. However, there were reports of hesitance to receiving the vaccine among the radiography workforce. This study was undertaken prior to the intended vaccination exercise to assess the willingness and concerns of radiographers to undergo the COVID-19 vaccination and to suggest recommendations to improve the vaccine uptake.

Methods

An ethically-approved online survey strategy was employed for this cross-sectional study conducted between 24th–28th February 2021. The survey employed quantitative questions and open text response options. Quantitative and open text responses were analysed using statistical and thematic analyses, respectively.

Results

There were 108 responses (response rate of 46.3%). The majority (n = 64, 59.3%) were willing to have the vaccine, however, some (n = 44, 40.7%) were not. The main reason behind their willingness to have the vaccine was its ability to reduce the spread of infections and lower mortality (n = 35, 54.7%). However, doubts about the vaccine's efficacy and side effects (n = 26, 56.8%), conspiracy theory concerns about its effects on the Ghanaian race (n = 4, 9.1%), and fertility concerns (n = 2, 4.5%) were some reasons for their hesitance to receive the vaccine. The open text commentary further revealed that the vaccine was thought of as a lifesaving medication, however, clinical safety concerns, lack of education/information and religious beliefs were affecting peoples' willingness to be vaccinated.

Conclusion

Our findings demonstrate the need for an urgent public health educational intervention to address the COVID-19 vaccine hesitancy concerns raised by radiographers to help increase the vaccine uptake.

Implication for practice

The study provides pertinent information to improve COVID-19 vaccine uptake among radiographers to limit the spread of infections.

The misunderstanding of vaccine efficacy

Although the efficacies of vaccines against SARS-CoV-2, i.e., the virus that causes Covid-19, have been publicized and praised, and although they are assumed to encourage vaccine compliance, little is known about how well these figures are understood by the general public. Our study aims to fill this gap by investigating whether laypeople have an adequate grasp of what vaccine efficacy means and, if not, which misconceptions and consequences are the most common. To this end, we carried out three online behavioral experiments involving 1800 participants overall. The first, exploratory experiment, with a sample of 600 UK participants, allowed us to document, by means of both an open-ended question and a multiple-choice question, a common misinterpretation of the efficacy of SARS-CoV-2 vaccines as the non-incidence rate among the vaccinated. We formally demonstrated that this error leads to a systematic overestimation of the probability of individuals who are vaccinated developing Covid-19. The second experiment confirmed the prevalence of this misinterpretation in a new sample of 600 UK and Italian participants, by means of a slightly different multiple-choice question that included more response options. Finally, in a third experiment, involving another 600 UK and Italian participants, we investigated the behavioral implications of the documented error and showed that it might undermine the general positive attitude toward vaccines as well as the intention to get vaccinated. On the whole, the results of this study reveal a general misunderstanding of vaccine efficacy that may have serious consequences for the perceived benefits of SARS-CoV-2 vaccines and, thus, the willingness to be vaccinated.

COVID-19 Vaccine Hesitancy in the LGBTQ+ Population: A Systematic Review

The coronavirus 2019 (COVID-19) pandemic has disproportionately impacted lesbian, gay, bisexual, transgender, queer (LGBTQ+) people. Despite developing safe and effective COVID-19 vaccines, LGBTQ+ communities still faces challenges due to inequitable access and vaccine hesitancy. Vaccine hesitancy is a delay in the acceptance or refusal of vaccines despite the availability of vaccination services. Various studies have explored and tried to address factors influencing vaccine hesitancy. However, the LGBTQ+ population remains under- and misrepresented in many of these studies. According to the few studies that have focused on the LGBTQ+ population, several factors influencing vaccine hesitancy have been identified, with the most common factors in studies being concern about vaccine safety, vaccine efficacy, and history of bad experiences with healthcare providers. In order to rebuild the confidence of LGBTQ+ people in vaccines, governments, healthcare policymakers, and healthcare providers need to start by acknowledging, and then resolving, these disparities; building trust; dismantling systemic suppression and discrimination; and prioritizing the inclusion of LGBTQ+ people in research studies and public health policies.

Acceptance of COVID-19 vaccines in Palestine: a cross-sectional online study

INTRODUCTION

In Palestine (West Bank and Gaza), there have been more than 320 890 known cases of COVID-19, resulting in 3452 deaths. The detrimental effects of the virus can be seen in the nation's health, economy and government operations, leading to radical uncertainty that is exacerbated by the absence of any definitive treatment or vaccines. The level of knowledge about and trust in treatment and vaccination varies worldwide. This study aims to assess the willingness of Palestinians to receive a COVID-19 vaccine and their knowledge about such vaccines.

METHODS

An online survey of adults over 18 years old (n=1080) was conducted in Palestine in October 2020. Using multivariate logistic regression, we identified correlates of participants' willingness to get a COVID-19 vaccine.

RESULTS

We found that about 63% of participants were willing to get a COVID-19 vaccine. However, acceptance varied with the specific demographic variables that were investigated. Women, married participants and those aged 18-24 years are more likely to take the vaccine. Further, participants with good knowledge about the vaccine and its side effects are more willing to get the vaccine.

CONCLUSION

The availability of a safe and effective COVID-19 vaccine in Palestine is crucial to decrease the burden of COVID-19 morbidity and mortality. In addition, to ensure a high vaccination rate, health awareness campaigns should target those who are not willing to get the vaccine, especially those who are more vulnerable and the elderly.

The landscape of COVID-19 vaccination among healthcare workers at the first round of COVID-19 vaccination in China: willingness, acceptance and self-reported adverse effects

The COVID-19 vaccines have been developed in a wide range of countries. This study aimed to examine factors that related to vaccination rates and willingness to be vaccinated against COVID-19 among Chinese healthcare workers (HCWs). From 3rd February to 18th February, 2021, an online cross-sectional survey was conducted among HCWs to investigate factors associated with the acceptance and willingness of COVID-19 vaccination. Sociodemographic characteristics and the acceptance of COVID-19 vaccination among Chinese HCWs were evaluated. A total of 2156 HCWs from 21 provinces in China responded to this survey (effective rate: 98.99%)), among whom 1433 (66.5%) were vaccinated with at least one dose. Higher vaccination rates were associated with older age, working as a clinician, having no personal religion, working in a fever clinic or higher hospital grade, and having received vaccine education, family history for influenza vaccination and strong familiarity with the vaccine. Willingness for vaccination was related to working in midwestern China, considerable knowledge of the vaccine, received vaccine education, and strong confidence in the vaccine. Results of this study can provide evidence for the government to improve vaccine coverage by addressing vaccine hesitancy in the COVID-19 pandemic and future public health emergencies.

COVID-19 Vaccine Hesitancy in the Month Following the Start of the Vaccination Process

The occurrence of the novel coronavirus has changed a series of aspects related to people's everyday life, the negative effects being felt all around the world. In this context, the production of a vaccine in a short period of time has been of great importance. On the other hand, obtaining a vaccine in such a short time has increased vaccine hesitancy and has activated anti-vaccination speeches. In this context, the aim of the paper is to analyze the dynamics of public opinion on Twitter in the first month after the start of the vaccination process in the UK, with a focus on COVID-19 vaccine hesitancy messages. For this purpose, a dataset containing 5,030,866 tweets in English was collected from Twitter between 8 December 2020-7 January 2021. A stance analysis was conducted after comparing several classical machine learning and deep learning algorithms. The tweets associated to COVID-19 vaccination hesitancy were examined in connection with the major events in the analyzed period, while the main discussion topics were determined using hashtags, n-grams and latent Dirichlet allocation. The results of the study can help the interested parties better address the COVID-19 vaccine hesitancy concerns.

Likelihood of COVID-19 vaccination by subgroups across the US: post-election trends and disparities

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted older individuals, those with lower educational attainment, and Black and Hispanic populations, yet vaccine hesitancy remains prevalent. Because widespread uptake of COVID-19 vaccines is critical to end the pandemic, addressing vaccine hesitancy is an important public health priority. Between April 1, 2020 and March 16, 2021, we have repeatedly surveyed a nationally representative online panel of adults and have tracked their stated likelihood of getting COVID-19 vaccinations. We present new evidence that in recent months disparities in self-reported likelihood of COVID-19 vaccination have narrowed by race/ethnicity, with an increasing proportion of Black individuals and Hispanic individuals indicating that they are likely to get a vaccine. At the same time, younger adults have progressively become less likely than older adults to state they will get a COVID-19 vaccine. Most vaccine-hesitant individuals are concerned about both vaccine efficacy and safety and do not trust the vaccine development or vaccine approval process. We conclude that outreach efforts to minority populations may be achieving their objectives in raising confidence in COVID-19 vaccines, but special outreach efforts are needed to address both vaccine hesitancy among younger adults and mistrust in the vaccine development and approval process.

Extended theory of planned behavior in explaining the intention to COVID-19 vaccination uptake among mainland Chinese university students: an online survey study

Objective: The Theory of Planned Behavior (TPB) is one of the most robust models in explaining health-related behavior. In this study, we tested the extended TPB to predict university students' intentions to uptake COVID-19 vaccination.Methods: An online cross-sectional survey was developed to investigate students' intention to uptake the COVID-19 vaccine based on the components of the TPB (i.e., attitude, subjective norms, and perceived behavioral control) and extended components (i.e., knowledge about COVID-19, risk perception of COVID-19, and past influenza vaccination behavior). Non-probability sampling was used to collect data from 3145 students from 43 universities in mainland China in January 2021. Structural equation modeling (SEM) was applied to examine the proposed model. Enrolled students were relatively young (mean age = 20.80 years; SD = 2.09), half of them are female (50.2%), and most of them were studying in undergraduate programs (n = 3026; 96.2%).Results: The results showed that students' knowledge of the COVID-19 vaccine and risk perception of COVID-19 positively influenced their attitude toward the uptake of a COVID-19 vaccine. Also, students' attitude toward COVID-19 vaccination uptake and their past influenza vaccination uptake behaviors were positively associated with the intention to uptake COVID-19 vaccination. Subjective norm and perceived behavioral control were not significant predictors for the intention to uptake COVID-19 vaccination (R2 = 0.49).Conclusions: The present study demonstrated that the extended TPB appears to be an efficient model with the focus on attitude, knowledge, risk perception, and past influenza vaccination uptake behaviors in explaining students' intention for COVID-19 vaccination.