Vaccine hesitancy and healthcare providers

COVID-19 Vaccination and Community Management: A Qualitative Study

BACKGROUND

Nurses play key roles as vaccination agents and frontline workers who deal with prejudice and misinformation. This study examined the attitudes and perceptions of nursing students regarding corona-virus disease 2019 (COVID-19) vaccination and its social and institutional management.

METHOD

This qualitative study consisted of an exploratory phase involving first- and fourth-year nursing students and a second phase using the PhotoVoice tool SHOWED mnemonic method followed by discussion groups with second-year nursing students.

RESULTS

Three themes emerged: (1) hope tinged with fear; (2) too much information generating fear, uncertainty, and mistrust; and (3) leaders without recognition or voice.

CONCLUSION

The results inform the body of knowledge in nursing science and enhance changes in clinical practice by providing new insights regarding the perceptions of nursing students on vaccination and its management, highlighting the need to train future nurses in health literacy and new ways to interact with community members. [J Nurs Educ. 2023;62(6):343-350.].

Physician Trust in the News Media and Attitudes toward COVID-19

CONTEXT

Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust.

METHODS

The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists.

FINDINGS

Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists.

CONCLUSIONS

Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates

BACKGROUND

Reaching the public health organizations targets of influenza vaccination in at-risk patient groups remains a challenge worldwide. Recognizing the relationship between the healthcare system characteristics and the economic environment of the population with vaccination uptake can be of great importance to improve.

METHODS

Several characteristics were correlated in this retrospective ecological study with data from 6.8 million citizens, 15,812 healthcare workers across 258 primary care health centers, and average income by area of the care center in Spain.

RESULTS

No correlation between HCW vaccination status and patient vaccination was found. A weak negative significant correlation between the size of the population the care center covers and their vaccination status did exist (6 mo.-59 yr., r = 0.19, p = 0.002; 60-64 yr., r = 0.23, p < 0.001; ≥65 yr., r = 0.23, p ≥ 0.001). The primary care centers with fewer HCWs had better uptake in the at-risk groups in the age groups of 60-64 yr. (r = 0.20, p = 0.002) and ≥65 (r = 0.023, p ≥ 0.001). A negative correlation was found regarding workload in the 6 mo.-59 yr. age group (r = 0.18, p = 0.004), which showed the at-risk groups that lived in the most economically deprived areas were more likely to be vaccinated.

CONCLUSIONS

This study reveals that the confounding variables that determine influenza vaccination in a population and in HCWs are complex. Future influenza campaigns should address these especially considering the possibility of combining influenza and SARS-CoV-2 vaccines each year.

Vaccine hesitancy among health-care professionals in the era of COVID-19

Health-care professionals (HCPs) are key trusted figures in addressing coronavirus disease 2019 (COVID-19) challenges. They are thought to influence others' health decisions by personal example. However, during the COVID-19 crisis, some HCPs hesitated to be vaccinated. We examined factors contributing to that decision. We performed 12 semi-structured interviews, between February and May 2021, with Israeli HCPs who had declined or delayed COVID-19 vaccination. Three coders conducted a combined top-down and bottom-up analysis. We identified four main themes shaping vaccine decision-making: (i) sources of information, (ii) perceptions of necessity and risks of the vaccine, (iii) individual versus collective responsibility and (iv) political climate and media influence. Participants were worried about long-term effectiveness and safety, and while many agreed that high-risk populations should be vaccinated, all considered themselves to be at low risk for serious disease. Some felt they should avoid taking a perceived risk (accepting a new vaccine) to protect society, although they felt pressured to do so. Vaccination campaign politization and the way the media approached the subject also contributed to mistrust and hesitancy to be vaccinated. These findings help us understand HCP beliefs and uncertainties about COVID-19 vaccinations. This study can help inform future campaigns targeted at HCPs to promote the acceptance of vaccines.

Individual and Contextual Determinants of Flu Vaccination Adherence: A University Nudge Intervention

INTRODUCTION

The University of Salerno has implemented a nudge intervention with the aim of promoting vaccine adherence among employees of academia and identifying individual and contextual determinants that influence adherence.

METHOD

A purpose-built questionnaire was used during the reference period of October-December 2022 in order to assess levels of state anxiety (STAI-Y1), perceived stress (PSS-10), and public sentiments, which influence vaccination behavior, with consequences for the whole population (VCI).

RESULTS

Analysis of the results revealed a difference in mean scores on the PSS: those who have always adhered to the vaccination campaign compared to those who have never been vaccinated perceived higher levels of stress (12.01 vs. 11.33; F = 4.744, p = 0.031); furthermore, there was a relationship between the presence/absence of pathologies and VCI (F = 3,93; df = 1; p = 0.04).

CONCLUSIONS

The University of Salerno's nudge intervention made its employees more responsible for protecting the health of the academic community and encouraged good adherence to the flu vaccination campaign. University employees, equipped with high cultural tools, sought information primarily from institutional sources indicated by the university during the free vaccination campaign at the university's vaccine center.

"I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.

Knowledge and Attitudes towards Human Papillomavirus Vaccination (HPV) among Healthcare Providers Involved in the Governmental Free HPV Vaccination Program in Shenzhen, Southern China

No research has been conducted to explore the variables associated with healthcare providers' (HCPs) knowledge and attitudes toward the human papillomavirus vaccine (HPV) since the vaccine was approved for free use in some Chinese cities. In Shenzhen, southern China, a convenience sample strategy was used to distribute questionnaires to HCPs involved in the government's HPV vaccination program from Shenzhen. There were 828 questionnaires collected in total, with 770 used in the analysis. The mean HPV and HPV vaccine knowledge score was 12.0 among HCPs involved in the government HPV vaccination program (with a total score of 15). the average scores for HPV and HPV vaccine knowledge varied among different types of medical institutions. District hospitals had the highest mean score of 12.4, while private hospitals ranked fourth with a mean score of 10.9. Multivariate logistic regression results revealed significant disparities in the type of license and after-tax annual income across HCPs (p < 0.05). The future education and training for HCPs should focus on private community health centers (CHCs), HCPs whose license type is other than a doctor, and HCPs with low after-tax annual income.

Qualitative assessment of COVID-19 vaccination acceptance among healthcare workers in Pima County

In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.

Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS)

Vaccine hesitancy is a barrier to improving childhood vaccination rates in Canada, but the scope of this problem is unclear due to inconsistent measurement of vaccine uptake indicators. Using 2017 data from a Canadian national vaccine coverage survey, this study analyzed the impact of demographics and parental knowledge, attitudes and beliefs (KAB) on vaccine decisions (refusal, delay and reluctance) in parents of 2-year-old children who had received at least one vaccine. The findings show that 16.8% had refused a vaccine, specifically influenza (73%), rotavirus (13%) and varicella (9%); female parents or those from Quebec or the Territories more likely to refuse. 12.8% were reluctant to accept a vaccine, usually influenza (34%), MMR (21%) and varicella (19%), but eventually accepted them upon advice from a health care provider. 13.1% had delayed a vaccine, usually because their child had health issues (54%) or was too young (18.6%) and was predicted by five or six person households. Recent immigration to Canada decreased likelihood of refusal, delay, or reluctance; however, after 10 years in Canada, these parents were as likely to refuse or be reluctant as parents born in Canada. Poor KAB increased likelihood of refusal and delay by 5 times, and reluctance by 15 times, while moderate KAB increased likelihood of refusal (OR 1.6), delay (OR 2.3) and reluctance (OR 3.6). Future research into vaccine decisions by female and/or single parents, and predictors of vaccine KAB would provide valuable information and help protect our children from vaccine preventable diseases.

Supporting US healthcare providers for successful vaccine communication

BACKGROUND

While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges.

OBJECTIVE

To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education.

METHODS

7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied.

RESULTS

44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment.

CONCLUSIONS

While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.

Provider confidence in counseling preconception, pregnant, and postpartum patients regarding COVID-19 vaccination: A cross-sectional survey study

Background and Aims

Healthcare provider counseling surrounding COVID-19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID-19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling.

Methods

A web-based anonymous survey was distributed via email to a cross-sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution-specific variables were included in the survey along with questions assessing both attitudes toward COVID-19 illness and confidence in counseling regarding the use of the vaccine in pregnancy.

Results

Almost all providers (151, 98.1%) reported that they received a COVID-19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty-one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English-speaking. Forty-three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID-19 vaccination in pregnancy were the Centers for Disease Control (112, 74.2%), hospital-specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists (82, 54.3%).

Conclusion

Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients.

Perspectives Associated with Human Papillomavirus Vaccination in Adults: A Qualitative Study

BACKGROUND

In the last several decades, vaccine hesitancy has become a significant global public health concern. The human papillomavirus (HPV) vaccine has been on the United States of America (USA) market since 2006, with extended approval up to age 45 granted in 2018. To date, there is limited research evaluating barriers and facilitators related to HPV vaccine initiation among adults and the influence of the COVID-19 pandemic on individuals' vaccine-related behaviors. This study's main objective was to characterize the contributing factors that could promote or inhibit HPV vaccine uptake for adults.

METHODS

A qualitative approach consisting of focus group discussions (FGDs) was used for this study. The FGD guide was informed by concepts from the Transtheoretical Model, Health Belief Model, and Social Cognitive Theory. All virtual FGDs were led by two researchers, who recorded audio for data collection. The data were transcribed by a third party, and the transcripts were imported into Dedoose^® software and analyzed using the six steps recommended by thematic analysis.

RESULTS

A total of 35 individuals participated in 6 focus groups over a 6-month period. Thematic analysis revealed four themes: (1) Intrinsic motivators for HPV vaccination, (2) Extrinsic motivators for HPV vaccination, (3) Vaccine promotion strategies, and (4) Impact of COVID-19 Pandemic on vaccine hesitancy.

CONCLUSION

Both intrinsic and extrinsic factors play a role in influencing HPV vaccine uptake, and such considerations can guide efforts to improve the odds of HPV vaccination in working-age adults.

Health workers' beliefs in COVID-19 conspiracy theories, level of trust in government information and their willingness to take COVID-19 vaccines: A survey from Nigeria

BACKGROUND

The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. The novel coronavirus disease 2019 (COVID-19) vaccines have been proven efficacious and central to combatting the pandemic. However, many - including skilled healthcare workers (HCWs) - have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy.

OBJECTIVE

The objective of this study was to investigate HCWs' beliefs in COVID-19 vaccines conspiracy theories (that the vaccines could alter one's DNA or genetic information; and that vaccines contain microchips) and trust in government information on COVID-19 vaccines.

METHODS

Healthcare workers in Ondo-State, Nigeria, representing different healthcare professions, were asked to participate anonymously in an online survey. The participants were asked about their beliefs in two viral conspiracy theories, and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and the beliefs in (a) DNA alteration, (b) microchip implant through the vaccine, and (c) willingness to accept the vaccine.

RESULTS

A total of 557 HCWs (28.0% men, 70.9% women) were included in the study. 26.4% (147/557) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30.0% (167/557) believed the vaccine could alter one's DNA or genetic information. The beliefs varied especially according to professional group, with 45.8% and 50.0% of the nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3% and 37.5% of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4% of HCWs. In total 76.2% of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines when compared to those with a high level of trust (OR 4.6, 95%CI 2.6-8.0). We observed a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95%CI 3.1-8.8).

CONCLUSIONS

Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips, and or that the vaccines could alter recipients' DNA and genetic information. This might have negative consequences in terms of their own COVID-19 vaccination and on their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for healthcare stakeholders in Nigeria and around the world to actively counteract misinformation especially on social media and give HCWs necessary scientifically sound information.

Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study

The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.

Views and Challenges of COVID-19 Vaccination in the Primary Health Care Sector. A Qualitative Study

COVID-19 has affected the global community as it has severely raised population mortality and morbidity rates. Vaccination was seen as a mechanism against the spread of the pandemic. Yet, there are still several reservations about its adoption. Professionals in the field of health care have a crucial frontline role. The present study uses a qualitative research approach to examine Greek health professionals' views on vaccination acceptance. According to the key findings, health professionals largely accept vaccination. The main reasons cited were scientific knowledge, a sense of obligation to society, and protection from disease. However, there are still numerous restrictions to adhering to it. This is due to the lack of knowledge of certain scientific disciplines or to misinformation, as well as to religious or political convictions. The issue of trust is central to the acceptance of vaccinations. According to our research, the most adequate strategy to enhance immunization and ensure that it is widely accepted is to promote health educational interventions for professionals working in primary care settings.

Healthcare professionals' beliefs regarding influenza vaccination: What has COVID-19 changed?

Background

Influenza poses a potential public health threat among healthcare professionals since an infected healthcare professional can spread the virus to patients at higher risk as well as his/her own family members and colleagues. Annual influenza vaccination is the most effective way to protect HCPs.

Aim

This study was conducted to determine whether demand for and beliefs about influenza vaccination have changed among healthcare professionals in the COVID-19 era and the factors that might have influenced them in the early phase of the pandemic when COVID-19 vaccines were eagerly awaited.

Patients and Methods

This observational descriptive study was conducted between November 16, and December 15, 2020. A total of 317 healthcare professionals completed an online survey. Bivariate analysis and binary logistic regression analysis were performed.

Results

Nineteen (6.0%) healthcare professionals were regularly vaccinated against influenza every year, and 199 (62.8%) had never been vaccinated. During the 2019-2020 season, 30 (9.5%) participants had been vaccinated and the proportion desiring to be vaccinated against influenza during the 2020-2021 season was 49.8% (n = 158). The results revealed that those with chronic diseases, those who believed they had adequate information about influenza vaccination and those who believed healthcare professionals should be vaccinated against influenza regularly every year, respectively, had 3.5 times, 4.7 times, and 11 times higher vaccination rates.

Conclusion

Although the proportion of healthcare professionals with the intention to be vaccinated for influenza increased with the COVID-19 pandemic, it is still not high enough. Influenza vaccination rates should be promoted by in-service training programs.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study

Background

Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR).

Methods

A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH.

Results

Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p &lt; 0.001), high-income countries residents (50.6%, p &lt; 0.001), and mothers with higher educational levels (52.1%, p &lt; 0.001). Parents of school-aged children (5–9 years) (55.6%, p &lt; 0.001), children free from any comorbidities (52.5%, p &lt; 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p &lt; 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p &lt; 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p &lt; 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p &lt; 0.001). The SEM suggested that mother’s age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH.

Conclusion

A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Uptake of COVID-19 vaccines and associated factors among adults in Uganda: a cross-sectional survey

OBJECTIVE

COVID-19 pandemic remains one of the most significant public health challenges ever faced globally. Vaccines are key to ending the pandemic as well as minimise its consequences. This study determined the uptake of COVID-19 vaccines and associated factors among adults in Uganda.

DESIGN, SETTING AND PARTICIPANTS

We conducted a cross-sectional mobile phone survey among adults in Uganda.

MAIN OUTCOME VARIABLE

Participants reported their uptake of COVID-19 vaccines.

RESULTS

Of the participants contacted, 94% (1173) completed the survey. Overall, 49.7% had received COVID-19 vaccines with 19.2% having obtained a full dose and 30.5% an incomplete dose. Among the unvaccinated, 91.0% indicated intention to vaccinate. Major reasons for vaccine uptake were protection of self from COVID-19 (86.8%) and a high perceived risk of getting the virus (19.6%). On the other hand, non-uptake was related to vaccine unavailability (42.4%), lack of time (24.1%) and perceived safety (12.5%) and effectiveness concerns (6.9%). The factors associated with receiving COVID-19 vaccines were older age (≥65 years) (Adjusted Prevalence Ratio (APR)=1.32 (95% CI: 1.08 to 1.61)), secondary (APR=1.36 (95% CI: 1.12 to 1.65)) or tertiary education (APR=1.62 (95% CI: 1.31 to 2.00)) and health workers as a source of information on COVID-19 (APR=1.26 (95% CI: 1.10 to 1.45)). Also, reporting a medium-income (APR=1.24 (95% CI: 1.02 to 1.52)) and residence in Northern (APR=1.55, 95% CI: 1.18 to 2.02) and Central regions (APR=1.48, 95% CI: 1.16 to 1.89) were associated with vaccine uptake.

CONCLUSIONS

Uptake of COVID-19 vaccines was moderate in this sample and was associated with older age, secondary and tertiary education, medium-income, region of residence and health workers as a source of COVID-19 information. Efforts are needed to increase access to vaccines and should use health workers as champions to enhance uptake.

COVID-19 vaccine hesitancy in Spain and associated factors

Introduction

The present study explores the reasons of those who have not been vaccinated in the later stage of the vaccine rollout in Spain and its associated determinants.

Methods

Cluster and logistic regression analyses were used to assess differences in claimed reasons for vaccine hesitancy in Spain using two samples of unvaccinated people (18–40 years old) gathered by an online cross-sectional survey from social networks (n = 910) and from a representative panel (n = 963) in October-November 2021.

Results

The main reasons for not being vaccinated were believing that the COVID-19 vaccines had been developed too fast, they were experimental, and they were not safe, endorsed by 68.7% participants in the social network sample and 55.4% in the panel sample. The cluster analysis classified the participants into two groups. Logistic regression showed that Cluster 2 (individuals who reported structural constraints and health-related reasons such as pregnancy or medical recommendation) presented a lower trust in information from health professionals, had a lower willingness to get vaccinated in the future, and avoided less social/family events than those in Cluster 1 (reasons centered in distrust on COVID-19 vaccines, conspiracy thoughts and complacency).

Conclusions

It is important to promote information campaigns that provide reliable information and fight fake news and myths. Future vaccination intention differs in both clusters, so these results are important for developing strategies target to increase vaccination uptake for those who do not reject the COVID-19 vaccine completely.

Perceptions of COVID-19 Vaccines: Protective Shields or Threatening Risks? A Descriptive Exploratory Study among the Italian Population

Although several quantitative studies have explored vaccine hesitancy, qualitative research on the factors underlying attitudes toward vaccination is still lacking. To fill this gap, this study aimed to investigate the general perceptions of COVID-19 vaccines among the Italian population with a qualitative approach. The sample included 700 Italian participants who completed an online survey. Open questions underwent a descriptive analysis for unveiling meaning categories, while differences in the prevalence of categories were calculated using chi-square or Fisher's exact tests. Vaccination was associated with the following seven main themes: 'safety', 'healthcare', 'vaccine delivery', 'progress', 'ambivalence', 'mistrust', and 'ethics'. Vaccinated individuals more frequently reported words related to the safety theme (χ2 = 46.7, p < 0.001), while unvaccinated individuals more frequently reported words related to mistrust (χ2 = 123, p < 0.001) and ambivalence (χ2 = 48.3, p < 0.001) themes. Working in the healthcare sector and being younger than 40 years affected the general perceptions of vaccination in terms of pro-vaccine attitudes. Unvaccinated individuals were more affected by the negative experiences of their acquaintances and manifested more distrust of scientific researchers, doctors, and pharmaceutical companies than vaccinated individuals. These findings suggest promoting collaborative efforts of governments, health policymakers, and media sources, including social media companies, in order to deal with cognitions and emotions supporting vaccine hesitancy.

Influenza Vaccination Behaviour of Healthcare Workers in Switzerland: A Cross-Sectional Study

Objectives: As no data are available regarding the influenza vaccination status of Swiss healthcare workers (HCW) in the ambulatory setting, this study aims to investigate their influenza vaccination behaviours.

Methods: We conducted an online survey using a four-item, semi-structured questionnaire to assess HCWs influenza vaccination coverage and behaviour. Associations between influenza vaccination status, age and language as well as recommendation behaviour and reasons for vaccination were assessed using descriptive statistics and logistic regression analyses.

Results: Of the 1057 completed questionnaires, 425 (40.2%) HCW were vaccinated and 632 (59.8%) not. 78.1% of the physicians and 47.3% pharmacists were vaccinated, compared to only 29.1% of the nurses, 24.3% pharmacy technicians and 13.0% medical practice assistants (MPA). There was a significant association between influenza vaccination status and HCW profession, age, language and how often an influenza vaccination recommendation was made.

Conclusion: Demographic factors seem to influence HCWs’ attitudes towards influenza vaccination, which in turn affects the prospect of them recommending the influenza vaccination. Diverse strategies might be necessary to encourage HCW to get vaccinated and hence, promote influenza vaccination.

Cultivating COVID-19 Vaccine Confidence in Pharmacy Professionals

Pharmacists promote vaccinations and challenge misconceptions about vaccine hesitancy, yet pharmacists' knowledge of vaccine confidence has not been assessed. The objective of this study was to compare pharmacists' knowledge of coronavirus disease 2019 (COVID-19) vaccine confidence before and after a live continuing education (CE) session. This pretest-posttest study evaluated the differences before and after a live CE session on COVID-19 vaccine confidence provided to pharmacists at a nationwide health technology company. Participants' total pretest and posttest scores were compared using paired t-tests, while pretest and posttest scores for each item were compared using chi-squared tests. A Bonferroni correction was applied, resulting in an alpha level of 0.005. A total of 279 pharmacists participated in this study. After the CE session, mean knowledge scores increased (5.2 ± 1.5 to 7.4 ± 1.35, p < 0.0001). After the CE session, there was no significant increase in pharmacists' knowledge about the approach that is not recommended when discussing vaccination beliefs with a patient (71.3% to 77.4%, p = 0.099), determinants of vaccine uptake (83.9% to 87.8%, p = 0.182), and social determinants of health that can influence vaccination rates (93.6% to 96.4%, p = 0.121). There was a significant change in pre- and posttest knowledge for the remaining seven items.

Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review

BACKGROUND

Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population.

OBJECTIVES

An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624).

METHODS

Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated.

RESULTS

19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective.

CONCLUSION

The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals' recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals' involvement, and interpersonal support are important strategies to improve uptake.

Pharmacists' attitudes toward influenza vaccination: does the COVID-19 pandemic make a difference?

Background

Influenza vaccine uptake in most European countries remains low, despite the World Health Organization's target of 75%. Community pharmacists play a vital role in promoting vaccination; however, they have been reported to be vaccine-hesitant. This study aimed to investigate changes in pharmacists' attitudes toward influenza vaccination since the onset of the COVID-19 pandemic, as well as their COVID-19 vaccination intentions.

Methods

In December 2020, all members of the Swiss Association of Pharmacists were invited to participate in an online, cross-sectional survey. This study assessed pharmacists' attitudes toward influenza vaccination by surveying influenza vaccine uptake during the 2019-20 influenza season and possible reasons for their decision(s), in addition to their intention to receive COVID-19 and seasonal influenza vaccination(s) during the 2020-21 influenza season. Descriptive analysis and multinomial logistic regression were used to assess predictors of vaccine uptake and intention.

Results

Of 5900 Swiss pharmacists, 569 (9.6%) completed the survey. The self-reported influenza vaccination coverage among pharmacists during the 2019-20 season was 48.0%. The primary reason for vaccine uptake was the belief that all healthcare workers should be vaccinated, whereas the main reason for refusal was a lack of concern about contracting influenza. The proportions of participants who intend to accept influenza and COVID-19 vaccinations in the 2020-2021 season, when available, were 63.3% and 66.5%, respectively. The most important predictor of high willingness to be vaccinated against influenza in 2020-21 was vaccination history (OR = 3.73; 95% CI = 1.47-9.50), while the most critical predictor of willingness to be vaccinated against COVID-19 was the intention to be vaccinated against influenza (OR = 3.45; 95% CI = 1.74-6.84).

Conclusions

Findings indicated that although pharmacists' readiness to accept seasonal influenza vaccination significantly increased during the COVID-19 pandemic, influenza vaccine uptake among them remains suboptimal. This is consistent with what has been reported in the literature.

Evidence-based policies in public health to address COVID-19 vaccine hesitancy

A fundamental basis for effective health-related policymaking of any democratic nation should be open and transparent communication between a government and its citizens, including scientists and healthcare professionals, to foster a climate of trust, especially during the ongoing COVID-19 mass vaccination campaign. Since misinformation is a leading cause of vaccine hesitancy, open data sharing through an evidence-based approach may render the communication of health strategies developed by policymakers with the public more effective, allowing misinformation and claims that are not backed by scientific evidence to be tackled. In this narrative review, we debate possible causes of COVID-19 vaccine hesitancy and links to the COVID-19 misinformation epidemic. We also put forward plausible solutions as recommended in the literature.

Exploring the Perceptions of Nurses on Receiving the SARS CoV-2 Vaccine in Palestine: A Qualitative Study

BACKGROUND

Uncertainty about vaccination among nurses are major barriers to managing the ongoing COVID-19 pandemic worldwide.

PURPOSE

To explore nurseś perceptions about receiving the SARS CoV-2 vaccine to inform the upcoming Palestinian Ministry of Health (MOH) vaccination efforts.

METHODS

Four focus groups were conducted with nurses between January 18 and 30, 2021, before MOH launched vaccinations in Palestine. Participants working in government and private facilities were invited to participate and completed an online or paper form to provide demographics, review the study purpose, and give consent. Meetings were facilitated in Arabic either online via the Zoom platform or face-to-face using the same interview guide. Transcripts were translated into English and coded using a template analysis approach.

RESULTS

Forty-six nurses, with a median age of 29.5y (range, 22-57) from across Palestine participated. Three major themes emerged: uncertainty, trust, and the knowledge needed to move forward. Uncertainty related to the evolving nature of COVID-19, the rapidity of vaccine development, the types and timing of available vaccines. The need for trusted experts to share scientific information about the vaccines to counteract the misinformation in social media. Moreover, reliable vaccine information may help vaccine-hesitant nurses move to vaccine-acceptors and to convince others, including their patients.

CONCLUSION

The negative perception of nurses towards vaccines is problematic in Palestine and uncertainty about which vaccine(s) will be available adds to the lack of education and mass-media misinformation. Other countries with vaccination efforts that are not wholly planned or implemented and may be struggling with similar concerns.

Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

The development of vaccines has significantly contributed to the success of disease prevention. However, there has been a sharp decline in immunization rates since COVID-19 spread globally. Seemingly overnight, the world shut down and most non-essential medical procedures were postponed. Since the COVID-19 vaccine became available, and the world started going back to normal these vaccine rates have not recovered. In this paper, we review the published literature to explore how convenience factors, perceived risk of vaccination, media or anti-vaccination ideals/movements, and healthcare professionals affect an individual’s compliance to be vaccinated to better understand the factors that contribute to the change in overall vaccination rates.

Barriers and Facilitators Affecting the Uptake of COVID-19 Vaccines: A Qualitative Perspective of Frontline Nurses in Namibia

Aim

Vaccinations remain one of the most effective measures to prevent and control the spread of COVID-19, while also reducing hospitalizations and deaths, yet many are unwilling to be vaccinated. This study explores the barriers and facilitators affecting the uptake of COVID-19 vaccines among frontline nurses.

Design

A qualitative, explorative, descriptive, and contextual research strategy was employed.

Methods

A sample of 15 nurses were selected via purposeful sampling to the point of data saturation. The participants were nurses at the COVID-19 vaccinations Centre in Rundu, Namibia. Data were collected using semistructured interviews and analyzed thematically.

Results

Three themes and 11 subthemes were identified, namely: (a) barriers, (b) facilitators, and (c) measures to increase the COVID-19 vaccine uptake. Barriers included living in deep rural areas, unavailability of vaccines, and misinformation, whereas scared of death, availability of COVID-19 vaccines, and family influence and peer pressure emerged as facilitators to the uptake of COVID-19 vaccines. Adoption of vaccination passport as a requirement to work premises and as an international travel requirement were the measures proposed to increase the COVID-19 vaccine uptake.

Conclusion

The study found several facilitators and barriers to COVID-19 vaccine uptake among frontline nurses. The identified barriers cover the individual, health system, and social factors hindering the COVID-19 vaccine uptake among frontline nurses. Whereas fear of COVID-19 deaths, family influence, and availability of vaccines were found to promote COVID-19 uptake. This study recommends targeted interventions to improve the uptake of COVID-19 vaccines.

Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden: a qualitative interview study

OBJECTIVES

To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance.

DESIGN

A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis.

SETTING

This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017.

PARTICIPANTS

Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents.

RESULTS

The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers.

CONCLUSION

From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.

COVID-19 vaccine refusal associated with health literacy: findings from a population-based survey in Korea

BACKGROUND

Poor health literacy is associated with lower utilization of preventable services. However, the relationship between health literacy and COVID-19 vaccine hesitancy remains controvertible.

METHODS

This study used data from 229,242 individuals who completed the Community Health Survey in Korea from August 16 to October 31 in 2021. To operationalize COVID-19 vaccine hesitancy, we measured vaccine refusal, which is defined as not having been vaccinated and not intending to get vaccinated against COVID-19. Health literacy is operationalized in two dimensions; the ability to understand spoken directions from health professionals and the ability to understand written information regarding health. Covariates include sex, age, educational level, marital status, employment status, basic living security pension status, and subjective health status. Two multivariable logistic regression models were run to determine factors associated with COVID-19 vaccine refusal. Model 1 included sociodemographic characteristics and subjective health status. Model 2 added two health literacy variables. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

Only 3.9% of the Korean adult population were estimated to refuse COVID-19 vaccine. The most commonly cited reasons for COVID-19 vaccine refusal were concerns about vaccine adverse events (47.6%), followed by the assessment of one's own health status (29.5%). Individuals who found spoken directions very difficult to understand were more likely to refuse COVID-19 vaccine than those who found spoken directions very easy (OR = 1.55, 95% CI: 1.28-1.87, p < 0.001). People who did not pay attention to written information were more likely to refuse COVID-19 vaccine than those who reported it to be very easy to understand (OR = 1.28, 95% CI: 1.13-1.45, p < 0.001). People in all other categories of the literacy spectrum for either spoken or written information did not have an increased risk of COVID-19 vaccine refusal.

CONCLUSION

Health literacy was significantly associated with COVID-19 vaccine refusal. Health literacy programs could be beneficial to reduce vaccine refusal, particularly for the people who find spoken directions from health professionals very difficult to understand and those who do not pay attention to written information.

Social and demographic patterns of influenza vaccination coverage in Norway, influenza seasons 2014/15 to 2020/21

AIMS

To examine influenza vaccination coverage among risk groups (RG) and health care workers (HCW), and study social and demographic patterns of vaccination coverage over time.

METHODS

Vaccination coverage was estimated by self-report in a nationally representative telephone survey among 14919 individuals aged 18-79 years over seven influenza seasons from 2014/15 to 2020/21. We explored whether belonging to an influenza RG (being >=65 years of age and/or having >=1 medical risk factor), being a HCW or educational attainment was associated with vaccination status using logistic regression.

RESULTS

Vaccination coverage increased from 27 % to 66 % among individuals 65-79 years, from 13 % to 33 % among individuals 18-64 years with >=1 risk factor, and from 9 % to 51 % among HCWs during the study period. Being older, having a risk factor or being a HCW were significantly associated with higher coverage in all multivariable logistic regression analyses. Higher education was also consistently associated with higher coverage, but the difference did not reach significance in all influenza seasons. Educational attainment was not significantly associated with coverage while coverage was at its lowest (2014/15-2017/18), but as coverage increased, so did the differences. Individuals with intermediate or lower education were less likely to report vaccination than those with higher education in season 2018/19, OR = 0.61 (95 % CI 0.46-0.80) and OR = 0.58 (95 % CI 0.41-0.83), respectively, and in season 2019/20, OR = 0.69 (95 % CI 0.55-0.88) and OR = 0.71 (95 % CI 0.53-0.95), respectively. When the vaccine was funded in the COVID-19 pandemic winter of 2020/21, educational differences diminished again and were no longer significant.

CONCLUSIONS

We observed widening educational differences in influenza vaccination coverage as coverage increased from 2014/15 to 2019/20. When influenza vaccination was funded in 2020/21, differences in coverage by educational attainment diminished. These findings indicate that economic barriers influence influenza vaccination decisions among risk groups in Norway.

Unraveling the dynamics of the Omicron and Delta variants of the 2019 coronavirus in the presence of vaccination, mask usage, and antiviral treatment

The effectiveness of control interventions against COVID-19 is threatened by the emergence of SARS-CoV-2 variants of concern. We present a mathematical model for studying the transmission dynamics of two of these variants (Delta and Omicron) in the United States, in the presence of vaccination, treatment of individuals with clinical symptoms of the disease and the use of face masks. The model is parameterized and cross-validated using observed daily case data for COVID-19 in the United States for the period from November 2021 (when Omicron first emerged) to March 2022. Rigorous qualitative analysis of the model shows that the disease-free equilibrium of the model is locally-asymptotically stable when the control reproduction number of the model (denoted by R c ) is less than one. This equilibrium is shown to be globally-asymptotically stable for a special case of the model, where disease-induced mortality is negligible and both vaccine-derived immunity in fully-vaccinated individuals and natural immunity do not wane, when the associated reproduction number is less than one. The epidemiological implication of the latter result is that the combined vaccination-boosting strategy can lead to the elimination of the pandemic if its implementation can bring (and maintain) the associated reproduction number to a value less than one. An analytical expression for the vaccine-derived herd immunity threshold is derived. Using this expression, together with the baseline values of the parameters of the parameterized model, we showed that the vaccine-derived herd immunity can be achieved in the United States (so that the pandemic will be eliminated) if at least 68 % of the population is fully-vaccinated with two of the three vaccines approved for use in the United States (Pfizer or Moderna vaccine). Furthermore, this study showed (as of the time of writing in March 2022) that the control reproduction number of the Omicron variant was approximately 3.5 times that of the Delta variant (the reproduction of the latter is computed to be ≈ 0.2782 ), indicating that Delta had practically died out and that Omicron has competitively-excluded Delta (to become the predominant variant in the United States). Based on our analysis and parameterization at the time of writing of this paper (March 2022), our study suggests that SARS-CoV-2 elimination is feasible by June 2022 if the current baseline level of the coverage of fully-vaccinated individuals is increased by about 20 % . The prospect of pandemic elimination is significantly improved if vaccination is combined with a face mask strategy that prioritizes moderately effective and high-quality masks. Having a high percentage of the populace wearing the moderately-effective surgical mask is more beneficial to the community than having low percentage of the populace wearing the highly-effective N95 masks. We showed that waning natural and vaccine-derived immunity (if considered individually) offer marginal impact on disease burden, except for the case when they wane at a much faster rate (e.g., within three months), in comparison to the baseline (estimated to be within 9 months to a year). Treatment of symptomatic individuals has marginal effect in reducing daily cases of SARS-CoV-2, in comparison to the baseline, but it has significant impact in reducing daily hospitalizations. Furthermore, while treatment significantly reduces daily hospitalizations (and, consequently, deaths), the prospects of COVID-19 elimination in the United States are significantly enhanced if investments in control resources are focused on mask usage and vaccination rather than on treatment.

Attitudes towards receiving COVID-19 vaccine and its associated factors among Southwest Ethiopian adults, 2021

INTRODUCTION

Many countries around the world are still affected by the global pandemic of coronavirus disease. The vaccine is the most effective method of controlling Coronavirus Disease 2019 (COVID-19). However, attitudes toward vaccination are heavily affected by different factors besides vaccine availability.

OBJECTIVES

This study aimed to determine community attitudes toward the COVID-19 vaccine in Gurage Zone, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from November 15th to December 15th, 2021. A simple random sampling technique was used to select 364 participants in the study area. An interview-administered structured questionnaire was used to collect the data; the data was entered into Epidata 3.1 version, and then exported to SPSS version 23 for further analysis. Descriptive statistics were used to determine the characteristics of study participants. Binary and multivariable logistic regression analyses with a p-value of less than 0.05 were used as a measure of significance.

RESULTS

In this study, 44.7% of study participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm [AOR: 1.85; 95% CI (1.15-2.96)], Having ever had a chronic disease [AOR: 3.22; 95% CI (2.02-5.14)], community belief on the effectiveness of the vaccine [AOR: 2.02; 95% CI (1.27-3.22)], and average monthly income 3001-5000 ETB [AOR: 0.54; 95% CI (0.30-0.97)], average monthly income 5001-10000 ETB [AOR: 0.48; 95% CI(0.27-0.86)] were statistically significantly towards COVID-19 vaccination.

CONCLUSIONS

Overall, less than half of the participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm, having ever had a chronic disease, community belief in the effectiveness of the vaccine, and average monthly income were determinant factors of the community's attitude toward COVID-19 vaccination. As a result, information conversation with the community's awareness of the COVID-19 vaccination in reducing vaccine-related suspicion.

Healthcare Workers' Attitudes toward Influenza Vaccination: A Behaviour and Social Drivers Survey

This study aimed to understand the intention and correlation of receiving and recommending influenza vaccine (IV) among healthcare workers (HCWs) in China during the 2022/2023 season using the behavior and social drivers (BeSD) tools. A self-administered electronic survey collected 17,832 participants on a media platform. We investigated the willingness of IV and used multivariate logistic regression analysis to explore its associated factors. The average scores of the 3Cs’ model were compared by multiple comparisons. We also explored the factors that potentially correlated with recommendation willingness by partial regression. The willingness of IV was 74.89% among HCWs, and 82.58% of the participants were likely to recommend it to others during this season. Thinking and feeling was the strongest domain independently associated with willingness. All domains in BeSD were significantly different between the hesitancy and acceptance groups. Central factors in the 3Cs model were significantly different among groups (p < 0.01). HCWs’ willingness to IV recommendation was influenced by their ability to answer related questions (r  =  0.187, p  <  0.001) after controlling for their IV willingness and perceived risk. HCWs’ attitudes towards IV affect their vaccination and recommendation. The BeSD framework revealed the drivers during the decision-making process. Further study should classify the causes in detail to refine HCWs’ education.

Safety of Vaccination within First Year of Life-The Experience of One General Medicine Center

Vaccines represent an important preventive strategy in paediatric populations, but the rate of vaccination has been constantly declining in the last decade. Concerns about vaccines' safety represent one of the main causes of vaccine hesitancy among parents. The aim of this study was the analysis of the immediate adverse reactions induced by vaccines included in the national program of immunization for the first year of life. Method: Eighty-one children born between 1st of January 2018 and 31st of March 2019 were included. The vaccination refusal rate, and incidence and severity of adverse effects induced by three mandatory vaccines (Hexavalent, Prevenar 13 and MMR) were analyzed. The level of parents' education and the sources of information that were consulted in order to understand the adverse effects were also analyzed. Results and conclusions: The rate of adverse events was lower than 30% of the total number of doses, and most of them were mild. The incidence and severity of vaccine-induced adverse effects were correlated with prematurity. The vaccine hesitancy rate was lower than the national one, possibly due to a high level of education and good information provided by doctors that might have led to parents' concerns regarding vaccination being answered.

What impact does the attitude toward COVID-19 vaccination have on physicians as vaccine providers? A cross sectional study from the German outpatient sector

BACKGROUND

COVID-19 vaccination is recognized as a key component in addressing the COVID-19 pandemic. Physicians' attitudes toward vaccination are known to play a defining role in the management and dissemination of medical advice to patients. In Germany, outpatient practitioners are predominantly responsible for the dissemination of vaccines.

METHOD

Using a cross-sectional online survey, 932 outpatient general practitioners, gynecologists, and pediatricians in Germany were asked in fall, 2021, about their attitude toward COVID-19 vaccination and - among others - their communication in vaccine discussions, their assessment of vaccine safety, and reporting of suspected adverse events. Physicians were divided into two groups along their attitudes toward COVID-19 vaccination. In addition, multivariate linear regression models were constructed to assess differences in communication strategies.

RESULTS

92 % of physicians had a positive or very positive attitude toward COVID-19 vaccination. Own vaccination status, practice-based vaccination delivery, and estimated vaccination coverage among patients were significantly associated with the attitude toward vaccination. Confidence in vaccine safety was significantly lower among physicians with negative attitudes. There were no differences between the two groups in self-assessment of the ability to detect suspected adverse events, but there were differences in the observing and reporting of adverse events. For the linear regression models, we found that a more negative attitude toward COVID-19 vaccination was significantly associated with increased acceptance of patient refusal of COVID-19 vaccination and empathic behavior for patient concerns. In contrast, willingness to engage in a detailed persuasion consultation was significantly lower. Pediatricians showed significantly higher empathy for patient-side concerns compared to general practitioners, whereas gynecologists showed less empathy than general practitioners.

DISCUSSION

The physician's attitude toward COVID-19 vaccination influences the physician's practices as a vaccine provider. However, when providing medical advice and healthcare, the physician should focus on the actual needs of the patient.

Vaccine hesitancy educational tools for healthcare providers and trainees: A scoping review

In the era of vaccine hesitancy, highlighted by the current SARS-CoV2 pandemic, there is an acute need to develop an approach to reduce and address apprehension towards vaccinations. We sought to map and present an overview of existing educational interventions for healthcare providers (HCPs) on strategies to engage in effective vaccine discussion. We applied the Joanna Briggs Institute methodology framework in this scoping review. We searched five relevant databases (MEDLINE, CINAHL, EMBASE, PsycInfo, and SCOPUS) and grey literature through the Google search engine using keywords and subject headings that were systematically identified. We identified 3384 citations in peer-reviewed literature and 41 citations in grey literature. After screening for our inclusion criteria, we included 28 citations from peer reviewed literature and 16 citations from grey literature for analysis. We identified a total of 41 unique education interventions. Interventions were available from multiple disciplines, training levels, clinical settings, and diseases/vaccines. Interventions predominantly centered around two foci: knowledge sharing and communication training. Most interventions identified from peer-reviewed literature were facilitated and were applied with multiple modes of delivery. Interventions from grey literature were more topical and generally self-directed. We identified several gaps in knowledge. Firstly, accessibility and generalizability of interventions was limited. Secondly, distribution of interventions did not adequately address nursing and pharmacy disciplines, and did not cover the breadth of medical specialties for whom vaccine discussions apply. Thirdly, no interventions addressed self monitoring and the clinicians' recognition and management of emotions during difficult conversations. There is a need to address this gap and provide available, credible and comprehensive educational interventions that will support our healthcare providers in effective communication with vaccine hesitant patients.

Factors affecting guardians' decision-making regarding the SARS-CoV-2 vaccine

BACKGROUND

In Japan, the vaccination rate against the SARS-CoV-2 vaccine for children was low. Therefore, in this study we investigated the factors influencing guardians' decision-making regarding vaccination of their children.

METHODS

From November 1, 2022 to March 31, 2023, pediatric clinics, departments, and midwifery clinics in Saitama Prefecture requested guardians of children under the age of 15 to complete an online questionnaire.

RESULTS

Responses were obtained from 894 guardians of children aged 6 months to 15 years; 142 had had one of their children vaccinated at least once and 629 had not had any of their children vaccinated. Among guardians who had not had any of their children vaccinated, "the Age of children" was significantly younger (p < 0.001) and "Prevalence" (p < 0.001), "Free vaccination" (p < 0.001), and "Intentions of national and local governments" (p = 0.005) were selected as reasons significantly less frequently in comparison to guardians who had vaccinated their children. "Japanese adverse reactions" (p < 0.001), "Japanese effectiveness" (p < 0.001), "Adverse reactions" (p < 0.001), "History of adverse reactions" (p < 0.001), and "Reputation of friends" (p = 0.006) were selected significantly more frequently by guardians who had not had any of their children vaccinated.

CONCLUSIONS

Guardians who had had one of their children vaccinated at least once emphasized the importance of prevalence and free vaccination. On the other hand, guardians who had not had any of their children vaccinated placed particular importance on adverse reactions and the Japanese data on effectiveness. To guide the decision-making of guardians, it is necessary to quickly collect and publish data on adverse reactions and effectiveness, particularly in Japanese individuals, so that citizens can decide whether to vaccinate themselves and their children.

Acceptability rate and barriers to COVID-19 vaccination among healthcare workers in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku-Awka, Nigeria

Background

Healthcare workers were at the forefront of the COVID-19 pandemic. The acceptability and uptake of COVID-19 vaccines among healthcare workers was an important strategy in halting the spread of the virus as well as the antecedent implications on global health and the world economy.

Objectives

This study aims to determine the acceptability rate and barriers to COVID-19 vaccination of frontline healthcare workers in Awka, Nigeria.

Design

This is an analytical cross-sectional study.

Methods

An online cross-sectional survey was conducted from February 2022 to April 2022 to obtain the data for this study. One hundred healthcare workers were studied. Acceptability rate and barriers to uptake of COVID-19 vaccination were outcome measures.

Results

The COVID-19 vaccination rate was 45.0% among healthcare workers in study area of Awka metropolis. Ages 30-39 years had the highest acceptance rate of COVID-19 vaccination, 19 (47.5%; p = 0.262) with a more female preponderance of COVID-19 vaccine acceptance compared to males [26 (41.3%) vs 16 (42.2%), p = 0.721]. The place of residence of respondents (urban vs rural) and their marital status (married vs single) appeared not to influence the acceptance of COVID-19 vaccination [(38 (42.2%) vs 3 (33.3%); p = 0.667; 25 (36.8% vs 17 (54.8%); p = 0.433)]. Years of work experience (<10 years vs >10 years) significantly affected COVID-19 vaccine acceptance [27 (45.8%) vs 12 (52.2%); p = 0.029]. Educational status and monthly income appeared not to influence vaccine uptake (p > 0.05, for both). A significant number of respondents were not sure why they should or should not take the COVID-19 vaccine [49 (92.5%) vs 35 (83.3%); p = 0.001].

Conclusion

The COVID-19 vaccination rate is still poor among healthcare workers in Awka metropolis. The majority of respondents do not know why they should or should not take COVID-19 vaccine. We therefore recommend robust awareness campaigns that will explain in clear terms the essence and efficacy of COVID-19 vaccination in order to improve vaccine acceptance.

Characteristics of Oklahoma Pediatricians Who Dismiss Families for Refusing Vaccines

Vaccine refusal is increasing. Objectives were to assess frequency of declining or dismissing patients who refuse vaccines, which vaccine(s) prompt pediatricians to decline/dismiss patients, and demographics of pediatricians who decline/dismiss patients. Active members of the Oklahoma American Academy of Pediatricians (AAP) were surveyed. Chi-square tests with non-overlapping 95% confidence intervals compared proportions of providers across various metrics. In all, 47% (48/103) versus 35% (34/98) reported declining versus dismissing patients for refusing vaccines, respectively. Pediatricians were unlikely to decline/dismiss patients if they refused influenza, human papilloma virus (HPV), or MenB vaccines. Pediatricians with more years in practice were less likely to decline 15% (9/62) versus 44% (16/36), P = 0.002 and dismiss 8% (5/62) versus 33% (12/36), P = 0.002 patients. Rural pediatricians were less likely than urban to decline 12% (2/17) versus 29% (26/89), P = NS and dismiss patients 0% (0/17) versus 21% (19/89), P = 0.04. Dismissing/declining patients for vaccine refusal is more common among Oklahoma pediatricians than nationally reported. Patterns differ by practice setting, years in practice, and specific vaccine refused.

International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries

BACKGROUND

Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries.

RESEARCH DESIGN AND METHODS

After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions.

RESULTS

2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors.

CONCLUSION

This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.

Factors influencing healthcare professionals' confidence in vaccination in Europe: a literature review

Health-care professionals (HCPs) have a fundamental role in vaccination, their own beliefs and attitudes affecting both their uptake and recommendation of vaccines. This literature review (n = 89) summarises evidence on HCPs’ perceptions of the risks and benefits of vaccination, trust, and perceptions of mandatory vaccination in Europe. HCPs across studies believed that vaccination is important to protect themselves and their patients. However, beliefs that some diseases such as influenza are less risky were reported by some HCPs as a reason for not getting vaccinated. Concerns about both short- and long-term side effects were identified among HCPs in most studies, such as those affecting the immune or neurological system. Mistrust toward health authorities and pharmaceutical industry was reported in some studies. The question of mandatory vaccination revealed mixed opinions, with some favoring self-determination and others viewing vaccination as a duty. This review highlights key factors influencing HCPs’ confidence in vaccination in Europe.

Knowledge and attitude on infant vaccination among university staff in Malaysian public university

OBJECTIVE

To determine the knowledge and attitude on infant vaccination among a couple of Universiti Putra Malaysia (UPM) staffs in Serdang, Selangor.

METHODS

A cross-sectional study was carried out involving 97 respondents. A cluster sampling technique for the categorization of the faculty in UPM to science-based and non-science-based is used. Then, fishbowl technique was adopted in selecting the faculty from the two categorizations, which consists of 1) science-based: Faculty Biotechnology and Science Biomolecule and Faculty of Science; 2) non-science-based: Faculty of Economics and Management and Faculty of Language and Communication. Consequently, a simple random method was used to choose the respondent based on the inclusion and exclusion criteria. Data on socio-demographic characteristic, knowledge and attitude regarding infant vaccination were collected using a modified and pretested questionnaire. The data then were analyzed using SPSS version 22.

RESULTS

Of 97 respondents, 78 (80.4%) had high knowledge, and 49 (50.5%) have moderate attitude regarding infant vaccination. Overall, science-based faculty and non-science-based faculty prevalence of refuse infant vaccination was 2.1%, 6.5%, respectively. There was a significant association between educational level and the knowledge (p < .05, p = .019). However, there was no significant association between socio-demographic and attitude. Other than that,, there was no association between knowledge and attitude among these two different types of faculty (P > .05, p = .256, p = .597).

CONCLUSION

Effort are needed for focusing on health education campaign with collaboration between health-care professionals, social media and community to improve their awareness for immunization.

Adult immunization practices, challenges and opportunities in Central America and the Caribbean: Advisory board proceedings

As individuals age, they become increasingly prone to infectious diseases, many of which are vaccine-preventable diseases (VPDs). Adult immunization has become a public health priority in the modern era, yet VPDs vaccination rates for adults are low worldwide. In Central America and Caribbean, national recommendations and vaccination practices in adults differ across countries, and adult vaccination coverage data are limited. An advisory board comprised infectious disease experts, pulmonologists, geriatricians, occupational health, and public health professionals for Central America and Dominican Republic was convened to: a) describe adult immunization practices in these countries; b) discuss challenges and barriers to adult vaccination; and c) find strategies to increase awareness about VPDs. The advisory board discussions reflect that national immunization guidelines typically do not include routine vaccine recommendations for all adults, but rather focus on those with risk factors. This is the case for influenza, pneumococcal, and hepatitis B immunizations. Overall, knowledge lacks about the VPD burden among health-care professionals and the general public. Even more, there is insufficient information on vaccinology for students in medical schools. Actions from the responsible authorities - medical schools and scientific societies which can advocate for vaccination and a better knowledge in vaccinology - can help address these issues. A preventive medicine culture in the workplace may contribute to the advancement of public opinion on vaccination. Promoting vaccine education and research could be facilitated via working groups formed by disease experts, public and private sectors, and supranational authorities, in an ethical and transparent manner.

Healthcare University Courses Fail to Improve Opinions, Knowledge, and Attitudes toward Vaccines among Healthcare Students: A Southern Italy Cross-Sectional Study

(1) Background: Healthcare providers have a crucial role in contrasting vaccine hesitancy (VH). We aimed to investigate opinions, knowledge, and attitudes toward vaccines in healthcare students (HS) at the University of Catania (Italy). (2) Methods: A survey was conducted from 1 October 2019 to 31 January 2020. Data on the opinions, knowledge, and attitudes of HS toward vaccinations were collected using an anonymous self-administered questionnaire. The opinion answers were added to calculate the VH index (<18 = low, 19−22 = medium, >23 = high). Data were summarized by the VH index, degree, year of study, and sex differences, using descriptive statistics. (3) Results: A total of 1275 students (53.7% females) participated in the study, with a median (IQR) age of 21 (19−22) years. The median level of VH was 20 (17−23), with slightly higher values in males. We found an inverse trend between VH and opinions, knowledge, and attitudes toward vaccines. The same trend was confirmed in all study courses. Furthermore, the comparison between sexes revealed a higher level of knowledge in women. (4) Conclusions: The results highlight a lack of knowledge about vaccines, as well as contrasting opinions and attitudes among future health professionals. Therefore, future interventions on these topics in the preparation of future healthcare providers are needed.

Innovation for infection prevention and control-revisiting Pasteur's vision

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

Understanding healthcare workers' knowledge and attitudes regarding the coronavirus disease 2019 (COVID-19) vaccine: Overcoming gaps to improve public health response

Vaccines serve as a major tool against the coronavirus disease 2019 (COVID-19) pandemic, but vaccine hesitancy remains a major concern in the United States. Healthcare workers (HCWs) strongly influence a patient's decision to get vaccinated. We evaluated HCW knowledge and attitudes regarding the COVID-19 vaccine.

Investigate Non-EPI Vaccination Recommendation Practice from a Socio-Ecological Perspective: A Mixed-Methods Study in China

The uptake of non-EPI vaccines, such as influenza and pneumonia vaccines, are very low in China compared to other countries. In China, immunization services are provided by dedicated vaccination service providers (VSPs), and their recommendation is the key to improve vaccine uptake. This study explores VSP recommendation practices for non-EPI vaccines from a socio-ecological perspective. A mixed-methods study, combining a questionnaire survey and key informant interviews, was conducted in Anhui, Shaanxi, and Guangdong provinces. 555 VSPs completed the valid questionnaire, and 49 VSPs participated in in-depth interviews. Among the surveyed VSPs, 51.54% stated that they always or often recommended non-EPI vaccines in work, and the remaining half reported that they sometimes or never recommended non-EPI vaccines. Most VSPs interviewed communicated about non-EPI vaccines with the public in an informed style, not a presumptive one, and provided the public with all the decision-making latitude. The infrequent recommendation of non-EPI vaccines was widely prevalent among Chinese VSPs regardless of their individual characteristics, and was mainly driven by the interpersonal relationship, institutional arrangement, and public policy. Firstly, the VSPs were concerned about conflicts arising from the recommendation of self-paid vaccines and the risk of adverse reactions following vaccination. Secondly, high workloads left them insufficient time to communicate about non-EPI vaccines. Thirdly, there was no performance assessment or financial incentive for VSPs to recommend non-EPI vaccination, and their main responsibility was around EPI vaccination. Therefore, multi-level socio-ecological systems around non-EPI vaccination should be improved to optimize the communication between VSPs and the public, which include a better system of legal redress to resolve potential misunderstandings between the VSPs and the public, more effective workload management through whole-process health information system and strengthening public health workforce, and the introduction of performance assessment and appropriate incentives on non-EPI vaccination.

Are We Prepared for the Next Pandemic? Management, Systematic Evaluation and Lessons Learned from an In-Hospital COVID-19 Vaccination Centre for Healthcare Workers

BACKGROUND

the organisation of a COVID-19 vaccination campaign for healthcare workers (HCWs) within a university hospital presents a challenge of a particularly large scale and urgency. Here, we evaluate the in-hospital vaccination process and centre for HCWs at LMU University Hospital in Munich, Germany.

METHODS

We executed a mixed-method process evaluation of the vaccination centre at LMU University Hospital during the first COVID-19 vaccination campaign. In a programme monitoring, we continuously assessed the implementation of the centre's operational management including personnel resources. In evaluating the outreach to and satisfaction of the target group with the centre and process, we executed two anonymous surveys aimed at the HCWs vaccinated at the in-hospital centre (1) as well as centre staff members (2).

RESULTS

staff numbers and process time per person were reduced several times during the first vaccination campaign. Lessons concerning appointment scheduling were learned. HCWs vaccinated at the in-hospital centre were satisfied with the process. A longer waiting time between admission and inoculation, perceived dissatisfying accessibility as well as an increased frequency of observed adverse events were linked to a reduced satisfaction. Comparatively subpar willingness to adhere to non-pharmaceutical measures was observed. Centre staff reported high satisfaction and a workload relatively equal to that of their regular jobs. Our outcomes provide references for the implementation of an in-hospital vaccination centre in similar settings.