The role of trust in the likelihood of receiving a COVID-19 vaccine: Results from a national survey

Patterns and mediators of racial and ethnic disparities in COVID-19 vaccine hesitancy among young adults

COVID-19 vaccines have been available for over a year, yet 26% of U.S. young adults remain unvaccinated. This study examines racial and ethnic disparities in young adult vaccine hesitancy and attitudes/beliefs that mediate disparities in vaccine hesitancy. Young adults (n = 2041;Mean[SD]:21.3[0.7] years-old) from a Los Angeles, CA, USA cohort were surveyed online in January-May 2021 and classified as vaccine hesitant (those who reported "Not at all likely"/"Not very likely" /"Slightly likely" to get vaccinated) versus non-hesitant (those who reported "Moderately likely"/"Very likely"/"Definitely likely" to get vaccinated or already vaccinated). Multivariable logistic regression was performed to examine racial/ethnic disparities in vaccine hesitancy. Factor analysis was conducted to create three subscales toward vaccination: positive, negative, and lack-of-access beliefs. Mediation analyses were performed to assess pathways from attitude/belief subscales to racial disparities in vaccine hesitancy. Overall 33.0% of respondents reported vaccine hesitancy. Black vs. White young adults had a higher prevalence of vaccine hesitancy (AOR[95%CI] = 4.3[2.4-7.8]), and Asians vs. Whites had a lower prevalence (AOR[95%CI] = 0.5[0.3-0.8]). Mediators explained 90% of the Black (vs. White) disparity in vaccine hesitancy, including significant indirect effects through positive belief-reducing (β = 0.23,p < .001) and negative belief-enhancing (β = 0.02,p = .04) effects. About 81% of the Asian (vs. White) disparity in vaccine hesitancy was explained by the three combined subscales, including significant positive belief-reducing (β = -0.18,p < .001) indirect effect. Substantial racial and ethnic disparities in young adult COVID-19 vaccine hesitancy were found, which were mediated by differences in attitudes and beliefs toward vaccination. Targeted education campaigns and messages are needed to promote equitable utilization of the effective vaccine.

Acculturation, trust to health care system, and attitudes to COVID-19 vaccination: A comparative study between Polish immigrants in Norway, Polish in Poland, and Norwegians in Norway

Fast deployment of safe and efficient COVID-19 vaccines has changed the course of the pandemic in many countries reducing COVID-19 death rates and allowing countries to abandon strict measures such as social distancing and restrictions to public events. The vaccination strategy, however, is based on the expected high vaccination rate in the population. Several studies have indicated vaccination hesitancy to be higher in ethnic minority communities, which can lead to unnecessary suffering and loss of lives, worsening pre-existing health inequalities and marginalization of ethnic minority groups. The aim of the present study was to investigate the relationships between acculturation to Norwegian culture, trust in health authorities, and attitude to COVID-19 vaccine among Polish immigrants in Norway. An internet-based survey including questions about attitude to COVID-19 vaccination and trust in the health care system was filled by 150 Polish immigrants in Norway, 256 Polish living in Poland, and 264 Norwegians living in Norway. In addition, the Polish immigrants also answered questions about acculturation to Norway. The results showed that the Polish immigrants in Norway had less positive attitudes to COVID-19 vaccination than the Norwegians, while they did not differ from Polish living in Poland. The Polish immigrants also indicated lower trust in the Norwegian health care system than the Norwegians. In regression analysis, the trust in the values of the health care system was the most important predictor of COVID-19 vaccination attitudes in all three samples. A path model showed that trust in the values of the health care system mediated the effects of acculturation to Norway on COVID-19 vaccination attitudes among Polish immigrants. These results underline the importance of taking ethnic minorities and immigrants into account in the health care system to reduce COVID-19 vaccination hesitancy.

Immigration enforcement exposures and COVID-19 vaccine intentions among undocumented immigrants in California

COVID-19 vaccines are effective in preventing COVID-19 infection, disease, and death. However, there is no data about vaccine intentions among the 10.7 million undocumented immigrants in the US. This study examined the associations between immigration enforcement exposure and vaccine intentions among undocumented immigrants in California. This community-engaged study partnered with immigrant organizations across California during the COVID-19 pandemic to recruit 366 study participants to an online survey regarding their attitudes about the COVID-19 vaccine and past exposure with the immigration enforcement system. Data collection occurred from September 2020 – February 2021 before the vaccine became available. Overall, 65% of study participants indicated that they would definitely get the vaccine were it to become available. In multivariable logistic regressions, an increase in immigration enforcement scores were associated with a 12% decrease in vaccine acceptance (aOR = 0.88, CI: 0.78–0.99). Additionally, undocumented women were 3.09 times more likely to report vaccine acceptance compared to undocumented men (CI: 1.79–5.35) and undocumented Asians were 57% less likely to report vaccine acceptance compared to undocumented Latinx immigrants (aOR = 0.43, CI: 0.21–0.88). Exposure to the immigration enforcement system may undermine public health efforts to prevent further transmission of COVID-19 by reducing acceptability of vaccines among immigrant populations.

Understanding the influence of political orientation, social network, and economic recovery on COVID-19 vaccine uptake among Americans

The COVID-19 pandemic poses unprecedented risks to the well-being of Americans. To control the pandemic, a sufficient proportion of the population needs to be vaccinated promptly. Despite the proven efficacy and widespread availability, vaccine distribution and administration rates remain low. Thus, it is important to understand the public behavior of COVID-19 vaccination. This study aims to identify determinants at multiple levels that promote or inhibit one's vaccine uptake. We combine individual-level data from a national survey conducted in the summer of 2021 with corresponding state-level indicators. Findings of multilevel logistic regression show that political orientation, social network, and economic recovery altogether have significant influence. We articulate that individual decision to take the vaccine are a function of their personal characteristics and are also rooted in their home state's political, public health, and economic contexts. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who take/refuse the vaccine provides essential information to leverage certain factors and maximize vaccine uptake to mitigate the pandemic's devastating impact.

Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis

Politics is ubiquitous in public health, but vaccines had never been weaponized to instill distrust to gain political advantage. In pandemic and post-pandemic scenarios, populist political parties could use vaccine-related issues to generate distrust in evidence-based knowledge. Therefore, some questions arise. What impact could populist political parties impinge on vaccination uptake rates through sowing political discontent? What could the medical institutions do to avoid the adverse effects that these political strategies could infringe? For answering these research questions, we first hypothesized that vaccine uptake was negatively associated with distrust in the institutions. Furthermore, we analyzed whether populism mediates this relationship. In doing so, we hypothesized a positive association between distrust and populism, because populists, mainly fueled by politically discontent citizens, offer hope of a better future, blaming their misfortune on the actions of the elite. Additionally, we hypothesized that those citizens with a higher level of political dissatisfaction, following the claims of the populist political parties, will have lower vaccine uptake results, because they will be discouraged from making the efforts to counter the pandemic. Based on a survey carried out by the European Commission that covered 27 E.U. + U.K. countries (totaling 27,524 respondents), this paper proves that an individual’s political discontent fully mediates the relationship between distrust in institutions and vaccine uptake. Targeting the vaccine-hesitant population is quite convenient for populists because they only need to convince a minority of citizens not to be vaccinated to achieve their destabilizing goals. New outbreaks will appear if the minimum herd immunity coverage is not reached, reinforcing a vicious circle of distrust in elites, in consequence. For tackling this matter, recommendations are given to institutional managers from a social marketing standpoint.

COVID-19 Vaccine Hesitancy and How to Address It

BACKGROUND

Although many Americans were anxious to see a vaccine developed to help restore a sense of normalcy to the COVID-19 pandemic, vaccine hesitancy is still a problem that hinders public health goals designed to stop the spread of the virus. With two mRNA vaccines available since early 2021 only 71% of Americans have received at least one dose of vaccine by November 30, 2021, with 60% of the population being fully vaccinated.

METHODS

This article discusses the risk factors of vaccine hesitancy, the factors influencing the unwillingness to accept vaccines approved and recognized as safe, characteristics of vaccine hesitancy among worker populations, and guidelines and resources for nurses.

CONCLUSIONS AND APPLICATION TO PRACTICE

The key for the nurse is to self-educate and proactively begin the discussion of vaccines with patients and co-workers, building trust with patients and peers, and helping motivate them to accept COVID-19 vaccines and make appointments to receive vaccinations. Overcoming the impact of low vaccination rates due to vaccine hesitancy is the first step toward closing the gap and achieving universal vaccination for all adults.

Parental COVID-19 Vaccine Hesitancy in Diverse Communities: A National Survey

OBJECTIVE

We surveyed a diverse group of US participants to understand parental coronavirus disease 2019 (COVID-19) vaccine hesitancy.

METHODS

We administered a telephone and online survey from May 7 to June 7, 2021 using stratified sampling to ensure robust sample sizes of racial and ethnic minorities. Of the 20,280 contacted, 12,288 respondents completed the survey (response rate 61%). We used chi-square tests and adjusted risk ratios to compare results by racial/ethnic group.

RESULTS

Overall, 23% of parents stated that they plan to (or have) vaccinated their children; 30% said that they would not vaccinate their children, and 25% were unsure. Latino/a, Native American, and Asian American-Pacific Islander (AAPI) parents were generally more likely to vaccinate their children than Black or White parents. After adjusting for demographic factors, AAPI parents were significantly more likely to vaccinate their children than were others. Of parents who said that they would not vaccinate their child, 55% stated it was due to insufficient research. However, over half of parents stated that they would follow their child's health care provider's recommendations. After adjusting for demographic factors, trust in their primary care doctor was significantly lower among AAPI, Black, and Native American parents than White parents.

CONCLUSIONS

Parental vaccine hesitancy was similar overall, but drivers of hesitancy varied by racial/ethnic groups. While the perception that vaccines had been "insufficiently researched" was a major concern among all groups, we found that parents are generally inclined to follow health providers' recommendations. Health professionals can play an important role in COVID-19 vaccine education and should provide access to vaccines.

Trust, Care Avoidance, and Care Experiences among Kenyan Women Who Delivered during the COVID-19 Pandemic

We explore how the COVID-19 pandemic was associated with avoidance of, and challenges with, antenatal, childbirth and postpartum care among women in Kiambu and Nairobi counties, Kenya; and whether this was associated with a report of declined trust in the health system due to the pandemic. Women who delivered between March and November 2020 were invited to participate in a phone survey about their care experiences (n = 1122 respondents). We explored associations between reduced trust and care avoidance, delays and challenges with healthcare seeking, using logistic regression models adjusted for women's characteristics. Approximately half of respondents said their trust in the health care system had declined due to COVID-19 (52.7%, n = 591). Declined trust was associated with higher likelihood of reporting barriers accessing antenatal care (aOR 1.59 [95% CI 1.24, 2.05]), avoiding care for oneself (aOR 2.26 [95% CI 1.59, 3.22]) and for one's infant (aOR 1.77 [95% CI 1.11, 2.83]), and of feeling unsafe accessing care (aOR 1.52 [95% CI 1.19, 1.93]). Since March 2020, emergency services, routine care and immunizations were avoided most often. Primary reported reasons for avoiding care and challenges accessing care were financial barriers and problems accessing the facility. Declined trust in the health care system due to COVID-19 may have affected health care-seeking for women and their children in Kenya, which could have important implications for their health and well-being. Programs and policies should consider targeted special "catch-up" strategies that include trust-building messages and actions for women who deliver during emergencies like the COVID-19 pandemic.

Impact of Vaccination on the Sense of Security, the Anxiety of COVID-19 and Quality of Life among Polish. A Nationwide Online Survey in Poland

The pandemic state has a destructive effect on the human psyche and induces fear for one’s own health. By reducing the risk of severe COVID-19, vaccination may indirectly improve the mental state. This study aims to assess the effects of vaccination on respondents’ mental well-being, their attitudes towards adherence to government recommendations limiting viral transmission, and to identify factors that may influence the decision to get vaccinated. The survey took the form of the authors’ own, fully voluntary, anonymous, online questionnaire. Standardised psychometric tools were used in the survey: Generalised Anxiety Disorder Assessment (GAD-7) and Manchester Short Assessment of Quality of Life (MANSA). The survey involved 1696 respondents, the vast majority of whom were women, and were aged 18–29. The vaccination status was declared by 1677 respondents (98.9%), 430 (25.4%) of whom were vaccinated with at least one dose of vaccine, while 303 (17.9%) respondents were not only unvaccinated at all, and declared no intention to get vaccinated in the future. Fully vaccinated individuals were found to have lower levels of anxiety, higher MANSA scores and lower subjective anxiety about being infected with COVID-19 than those awaiting vaccination or those with an incomplete vaccination regimen (one dose). Those who are not willing to get vaccinated have the lowest sense of anxiety and fear of being infected and they have the lowest adherence to government recommendations limiting SARS-CoV-2 transmission. Conclusions: COVID-19 vaccination reduces the level of anxiety about being infected and anxiety due to COVID-19 disease in people from the immediate environment. Those who are not willing to get vaccinated have extreme attitudes that negate the pandemic as a whole, including the need for COVID-19 vaccination. Fully vaccinated individuals still adhere to the SARS-CoV-2 prevention policies in place.

An Understanding of the Drivers of Infectious Diseases in the Modern World Can Aid Early Control of Future Pandemics

Infectious diseases have been a significant challenge to health and wellbeing from ancient times, with substantial economic implications globally. Despite the advent of technology, infectious diseases continue to affect people of various social statuses and across geographical locations. Understanding some of the drivers of infectious diseases, antimicrobial resistance, vaccination, and vaccine hesitancy is a step towards thriving in the modern world, achieving fewer morbidities and mortalities, and adequately controlling future pandemics. Pharmacists are strategically placed as healthcare team members to promote early disease control through health education, advocacy, cross-professional and specialty collaboration, communal trust-building, research, and global unity. Not forgetting that infectious diseases in the modern world are about people and science, credible crisis communication during the early phases of disease outbreaks paves the way for well-informed guidance globally.

COVID-19 vaccine hesitancy and acceptance among individuals with cancer, autoimmune diseases, and other serious comorbid conditions: A cross-sectional internet-based survey

Background

Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes.

Objective

We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated.

Methods

We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance.

Results

Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively.

Conclusions

In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual’s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care–related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role.

Factors Associated with a Lack of Willingness to Vaccinate against COVID-19 in Poland: A 2021 Nationwide Cross-Sectional Survey

We aimed to assess the factors associated with a lack of willingness to vaccinate against COVID-19 among adults in Poland three months after the introduction of mass vaccination against COVID-19 in Poland. This cross-sectional study was carried out between 8 and 18 April 2021 on a representative nationwide sample of 1131 inhabitants of Poland aged 18 and over. Almost one-third of adult inhabitants of Poland (30%; 95%CI: 27.4–32.7%) declared a lack of willingness to vaccinate against COVID-19. Females had higher odds of refusing COVID-19 vaccination compared with males (OR = 1.68; 95%CI: 1.25–2.27). The lack of higher education was significantly (p < 0.001) associated with greater odds of refusing the COVID-19 vaccination. Participants living in rural areas compared with those living in the largest cities (over 500,000 inhabitants) had three times higher odds of refusing the COVID-19 vaccination (OR = 3.20; 95%CI: 1.71–6.01). Respondents who declared willingness to vote for one of the right-wing political parties publicly supporting the anti-vaccination movement in Poland had eight times higher odds (OR = 8.01; 95%CI: 3.65–17.60) of refusing the COVID-19 vaccination compared with other groups. Moreover, those who had three children or more, respondents who declared passivity towards participating in religious practices as well as active internet users had significantly higher odds of refusing the COVID-19 vaccination.