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

Reasons for not getting COVID-19 vaccine in Ardabil, a Northwestern province in Iran: Based on an ecological approach

BACKGROUND

Understanding the reasons for not getting the COVID-19 vaccine can help to increase acceptability and tackle vaccine hesitancy and consequently reach high coverage for this new vaccine. Using an ecological approach, the reasons for not getting the vaccine in the Iranian population was investigated.

METHODS AND MATERIAL

This study was conducted from October to December 2021 on 426 participants who had not received the COVID-19 vaccine. The following subsets of questions were included in the questionnaire: intrapersonal level factors, interpersonal level factors, group and organization, and society and policy-making. Multivariable logistic regression was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated for vaccine hesitancy (dependent variable) according to the reasons for not getting COVID vaccine scores (independent variable) using multivariable logistic regression in 3 different models, including Model 0: unadjusted, Model 1: adjusted for age, gender, and underlying disease, and Model 2: adjustment for age, gender, underlying disease, education, place of living, income, marital status, and employment.

RESULTS

A significant difference was found regarding gender between likely and not likely groups (P = 0.016). A significant association was observed between the vaccine hesitancy and interpersonal (unadjusted model: OR = 0.833 (CI: 0.738-0.942), P for trend = 0.003; model 1: OR = 0.820 (CI: 0.724-0.930), P for trend = 0.002; model 2: OR = 0.799 (CI: 0.703-0.909), P for trend = 0.001) and group and organization (unadjusted model: OR = 0.861 (CI: 0.783-0.948), P for trend = 0.002; model 1: OR = 0.864 (CI: 0.784-0.952, P for trend = 0.003; model 2:OR = 0.862 (CI: 0.781-0.951, P for trend = 0.003). There was no significant association between vaccine hesitancy and intrapersonal and society and policy-making (P > 0.05).

CONCLUSIONS

We found that a high score of "interpersonal" and "group and organization" factors were associated with lower intention to COVID vaccine. Moreover, women had higher vaccination intentions than men.

Vaccine Confidence and Uptake of the Omicron Bivalent Booster in Tennessee: Implications for Vulnerable Populations

The COVID-19 Omicron variant and its subvariants are now the dominant variants circulating in the US. Therefore, the original COVID-19 vaccine cannot offer full protection. Instead, vaccines that target the spike proteins of the Omicron variants are warranted. Hence, the FDA recommended the development of a bivalent booster. Unfortunately, despite the safety and immunogenicity of the Omicron bivalent boosters from Pfizer and Moderna, uptake in the US has been poor. At this time, only 15.8% of individuals in the US aged five and older have received the Omicron bivalent booster (OBB). The rate is 18% for those aged 18 and older. Poor vaccine confidence and booster uptake are often fueled by misinformation and vaccine fatigue. These result in more problems associated with vaccine hesitancy, which are particular prevalent in Southern states in the US. In Tennessee, the OBB vaccination rate for eligible recipients is only 5.88% at time of writing (16 February 2023). In this review, we discuss (1) the rationale for developing the OBBs; (2) the efficacy and safety of the bivalent boosters; (3) the adverse events associated with these boosters; (4) vaccine hesitancy associated with the OBBs uptake in Tennessee; (5) implications for vulnerable populations, disparities in uptake of OBBs in Tennessee, and strategies to improve vaccine confidence and OBB uptake. In support of public health, it is essential that we continue to provide education, awareness, and vaccine access to the vulnerable and medically underserved populations in Tennessee. Receiving the OBBs is the most effective method to date of protecting the public against severe COVID disease, hospitalization, and death.

A Qualitative Investigation on COVID-19 Vaccine Hesitancy in Neurodivergent Communities

Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization and death due to COVID-19, highlighting the need for further research specifically on ND communities. We conducted a qualitative analysis using in-depth interviews with medical professionals, non-medical health professionals and communicators, and ND individuals or their caregivers. Using a thematic coding analysis methodology, trained coders identified major themes according to 24 distinct codes spanning across the categories of (1) barriers to vaccination; (2) facilitators to vaccination; and (3) suggestions for improving vaccine confidence. Qualitative findings identify misinformation, perception of vaccine risk, sensory sensitivities, and structural hardship as the most significant barriers to COVID-19 vaccination. We highlight the importance of accommodations to vaccination for the ND community alongside coordinated efforts by healthcare leaders to direct their communities to accurate sources of medical information. This work will inform the direction of future research on vaccine hesitancy, and the development of programs specific to the ND community's access to vaccines.

Analysis of Differences in User Groups and Post Sentiment of COVID-19 Vaccine Hesitators in Chinese Social-Media Platforms

(1) Background: The COVID-19 epidemic is still global and no specific drug has been developed for COVID-19. Vaccination can both prevent infection and limit the spread of the epidemic. Eliminating hesitation to the COVID-19 vaccine and achieving early herd immunity is a common goal for all countries. However, efforts in this area have not been significant and there is still a long way to go to eliminate vaccine hesitancy. (2) Objective: This study aimed to uncover differences in the characteristics and sentiments of COVID-19 vaccine hesitators on Chinese social-media platforms and to achieve a classification of vaccine-hesitant groups. (3) Methods: COVID-19-vaccine-hesitation posts and user characteristics were collected on the Sina Microblog platform for posting times spanning one year, and posts were identified for hesitation types. Logistic regression was used to conduct user-group analysis. The differences in user characteristics between the various types of COVID-19 vaccine posts were analysed according to four user characteristics: gender, address type, degree of personal-information disclosure, and whether they followed health topics. Sentiment analysis was conducted using sentiment analysis tools to calculate the sentiment scores and sentiment polarity of various COVID-19 vaccine posts, and the K-W test was used to uncover the sentiment differences between various types of COVID-19-vaccine-hesitation posts. (4) Results: There are differences in the types of COVID-19-vaccine-hesitation posts posted by users with different characteristics, and different types of COVID-19-vaccine-hesitation posts differ in terms of sentiment. Differences in user attributes and user behaviors are found across the different COVID-19-vaccine-hesitation types. Ultimately, two COVID-19-vaccine-hesitant user groups were identified: Body-related and Non-bodily-related. Users who posted body-related vaccine-hesitation posts are more often female, disclose more personal information and follow health topics on social-media platforms. Users who posted non-bodily-related posts are more often male, disclose less personal information, and do not follow health topics. The average sentiment score for all COVID-19-vaccine-hesitant-type posts is less than 0.45, with negative-sentiment posts outweighing positive- and neutral-sentiment posts in each type, among which the "Individual rights" type is the most negative. (5) Conclusions: This paper complements the application of user groups in the field of vaccine hesitation, and the results of the analysis of group characteristics and post sentiment can help to provide an in-depth and comprehensive analysis of the concerns and needs of COVID-19 vaccine hesitators. This will help public-health agencies to implement more targeted strategies to eliminate vaccine hesitancy and improve their work related to the COVID-19 vaccine, with far-reaching implications for COVID-19-vaccine promotion and vaccination.

Demographic and Psychosocial Correlates of COVID-19 Vaccination Status among a Statewide Sample in Texas

The COVID-19 pandemic has been a global public health concern since early 2020 and has required local and state-level responses in the United States. There were several Food and Drug Administration (FDA) approved vaccines available for the prevention of COVID-19 as of August 2022, yet not all states have achieved high vaccination coverage. Texas is a particularly unique state with a history of opposing vaccination mandates, as well as a large and ethnically/racially diverse population. This study explored the demographic and psychosocial correlates of COVID-19 vaccinations among a statewide sample in Texas. A quota sample of 1089 individuals was surveyed online from June-July 2022. The primary outcome in this study was COVID-19 vaccination status (fully vaccinated, partially vaccinated, or unvaccinated) and included independent variables related to demographics, COVID-19 infection/vaccine attitudes and beliefs, and challenges related to the COVID-19 pandemic. Hispanic/Latinx individuals were more likely than non-Hispanic White individuals to be partially vaccinated as opposed to unvaccinated. Higher education levels and confidence that the FDA would ensure a safe COVID-19 vaccine were strongly associated with a higher likelihood of being fully vaccinated. In addition, some challenges brought on by the pandemic and concerns about becoming infected or infecting others were associated with a higher likelihood of being partially or fully vaccinated. These findings emphasize the need to further investigate the interaction between individual and contextual factors in improving COVID-19 vaccination rates, especially among vulnerable and disadvantaged populations.

COVID-19 Vaccine Refusal and Delay among Adults in Italy: Evidence from the OBVIOUS Project, a National Survey in Italy

BACKGROUND

Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine.

METHODS

A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method.

RESULTS

In our sample, 83.2% stated that they were vaccinated as soon as possible ("vaccinators"), 8.0% delayed vaccination ("delayers"), and 6.7% refused to be vaccinated ("no-vaccinators"). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master's degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of "delayers" or "no-vaccinators". Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators).

CONCLUSION

In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments.

Understanding the barriers and facilitators of vaccine hesitancy towards the COVID-19 vaccine in healthcare workers and healthcare students worldwide: An Umbrella Review

BACKGROUND

Healthcare workers (HCWs) and healthcare students display high levels of vaccine hesitancy with impact on healthcare provision, patient safety, and health promotion. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, this evidence needs to be synthesised, as interventions to reduce vaccination hesitancy in this population are needed.

METHODS

This Umbrella Review aimed to explore the barriers and facilitators of vaccine hesitancy toward the COVID-19 vaccine for HCWs and healthcare students. The review was performed and reported in accordance with Joanna Briggs Institutes guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A protocol was preregistered on PROSPERO (CRD42022327354). Eight databases were searched from November 2019 to 23rd May 2022 to identify any systematic reviews that explored factors associated with hesitancy towards the COVID-19 vaccine for HCWs or healthcare students.

RESULTS

A total of 31 studies were included in the review. The majority of studies (71%) were appraised as strong or moderate quality and there was a slight degree of overlap (<5%) of primary studies between the reviews. Vaccine hesitancy was more common among HCWs and healthcare students in specific occupational roles (e.g. nurses) than others (e.g. physicians). Frequent reasons for hesitancy were related to sociodemographic factors (gender, age, ethnicity), occupational factors (COVID-19 exposure, perceived risk, mandatory vaccination), health factors (vaccination history), vaccine-related factors (concerns about safety, efficacy, side-effects, rapid development, testing, approval and distribution of the vaccine), social factors (social pressure, altruism and collective responsibility), distrust factors (key social actors, pandemic management), information factors (inadequate information and sources, exposure to misinformation).

CONCLUSION

The results from this Umbrella Review have wide-reaching implications for the research area, healthcare systems and institutions and governments worldwide. Designing tailored strategies for specific occupational groups is pivotal to increasing vaccine uptake and securing a safe healthcare provision worldwide.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago

BACKGROUND

A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas.

METHODS

Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI).

RESULTS

Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree).

CONCLUSIONS

Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity.

CLINICAL TRIALS NUMBER

NCT03584490.

Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

BACKGROUND

COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19.

PURPOSE

To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England.

METHODS

An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making.

RESULTS

Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London).

CONCLUSIONS

Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

The impact of educational interventions on COVID-19 and vaccination attitudes among patients in Michigan: A prospective study

Background

Mass vaccination serves as an effective strategy to combat the COVID-19 pandemic. Vaccine hesitancy is a recognized impediment to achieving a vaccination rate necessary to protect communities. However, solutions and interventions to address this issue are limited by a lack of prior research.

Methods

Over 200 patients from 18 Michigan counties participated in this study. Each participant received an initial survey, including demographical questions and knowledge and opinion questions regarding COVID-19 and vaccines. Participants were randomly assigned an educational intervention in either video or infographic format. Patients received a post-survey to assess changes in knowledge and attitudes. Paired sample t-tests and ANOVA were used to measure the effectiveness of the educational interventions. Participants also elected to complete a 3-month follow-up survey.

Results

Patients showed increased knowledge after the educational intervention in six out of seven COVID-19 topics (p &lt; 0.005). There was increased vaccine acceptance after the intervention but no difference in the effectiveness between the two intervention modalities. Post-intervention, more patients believed in CDC recommendations (p = 0.005), trusted the vaccine (p = 0.001), believed the vaccines had adequate testing (p = 0.019), recognized prior mistreatment in the medical care system (p = 0.005), agreed that a source they trust told them to receive a vaccine (p = 0.015), and were worried about taking time off of work to get a vaccine (p = 0.023). Additionally, post-intervention, patients were less concerned about mild reactions of the virus (p = 0.005), the rapid development of the vaccines (p &lt; 0.001), and vaccine side effects (p = 0.031). Data demonstrated that attitude and knowledge improved when comparing pre-educational intervention to follow-up but decreased from post-intervention to follow-up.

Conclusion

The findings illustrate that educational interventions improved COVID-19 and vaccine knowledge among patients and that the knowledge was retained. Educational interventions serve as powerful tools to increase knowledge within communities and address negative views on vaccination. Interventions should be continually utilized to reinforce information within communities to improve vaccination rates.

Communication and Perspectives About COVID-19 and Vaccinations Among Native Americans

The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.

Provision of and trust in COVID-19 vaccines information: Perspectives of people who have had COVID-19

AIM

The aim of this study was to understand the provision and need, quality of and trust in COVID-19 vaccines information from the perspectives of people who have had COVID-19 infection.

METHOD

People who have had a COVID-19 infection were approached via their general practice and invited to participate in the Nivel Corona Cohort. They completed questionnaires at baseline (Q1), and at three months (Q2). Outcome measures were based on health information-seeking behaviour, as used in the Comprehensive Model of Information Seeking. Antecedents (i.e., gender, age, education level, health literacy) were used from Q1, and one's beliefs and experiences (i.e., trust in the information and healthcare system, how applicable the information is), information carrier factors (i.e., information quality perceptions and via which sources), health-information seeking actions (i.e., decision to vaccinate and information sufficiency) and vaccination status from Q2. Data were analysed using descriptive analyses, analysis of variance tests (F-tests) and χ² tests with the statistical software STATA.

RESULTS

Of the respondents (N = 314), 96% were vaccinated at least once, mostly after having had the virus. Most retrieved information about COVID-19 vaccines on the website of the National Institute for Public Health and the Environment (79%), broader via the internet (56%), or from family and friends (35%). Almost all had trust in the information (89%) and healthcare system (94%). Most found the information applicable to their situation (67%). Moreover, most perceived the information as correct (71%) and did not perceive the information to be misleading (85%), while fewer people found the information reliable (59%) and clear (58%). Overall, the majority indicated that the information met their expectations to make a well-informed decision to vaccinate (89%).

CONCLUSION

Different characteristics of people who had COVID-19 and sought information were identified, which is important to offer tailored information. People who had COVID-19 in this study, mainly middle-aged, vaccinated and highly educated, were generally positive about the vaccines information, but overall the reliability and clarity could be improved. This is important for a high vaccination uptake, booster programs and coming pandemics.

PATIENT OR PUBLIC CONTRIBUTION

The questionnaire was reviewed by patients who had COVID-19, one of whom is a health services researcher.

COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample

Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.

Social and structural determinants of COVID-19 vaccine uptake among racial and ethnic groups

Latino, Black, American Indian/Alaska Native (AI/AN), and Native Hawaiian or Other Pacific Islander people have the highest hospitalizations and death rates from COVID-19. Social inequalities have exacerbated COVID-19 related health disparities. This study examines social and structural determinants of COVID-19 vaccine uptake. Results from logistic regressions suggest Latino and Black people were less likely to be vaccinated. People that did not have health insurance, a primary care doctor and were unemployed were more than 30% less likely to be vaccinated for COVID-19. Greater perceived health inequalities in one's neighborhood and perceived racial/ethnic discrimination were associated with a decreased odds in being vaccinated. People that suffered the loss of a household member from COVID-19 were three times more likely to have been vaccinated. Establishing policies that will increase access to health insurance and create jobs with living wages may have lasting impacts. Furthermore, collaboration with local and national community organizations can enhance the development of sustainable solutions.

Shifting Mobility Behaviors in Unprecedented Times: A Multigroup MIMIC Model Investigating Intentions to Use On-Demand Ride Services During the COVID-19 Pandemic

The spread of COVID-19 has been a major disruptive force in people's everyday lives and mobility behavior. The demand for on-demand ride services, such as taxis and ridehailing, has been specifically affected given both restrictions in service operations and users' concerns about virus transmission in shared vehicles. In the early months of the pandemic, demand for these modes decreased by as much as 80%. This study examines intentions to use on-demand ride services in the early lockdown stage of the pandemic in the United States, a period of unprecedented mobility reductions, changing household routines and transforming travel behaviors. Using data from a survey disseminated in June 2020 to 700 U.S. respondents, we use multigroup MIMIC (Multiple Indicator Multiple Cause) models to investigate the stated shift in intentions to use on-demand modes of travel. By using group-based segmentation we control for variation in ridership intentions according to personal, household, attitudinal factors, and pandemic experiences. The results point to a reduction across the board in the likelihood of using on-demand mobility associated with a significant COVID-19 effect. Beyond this general decrease, several groups are found to have more positive intentions, including younger adults, urban residents, graduate-degree holders, and people of Hispanic, Latino, Asian, and Pacific Islander ethnicities/races. The attitudinal effect of "tech-savviness" drives higher user intentions, revealing indirect effects of gender, education, and age. Multigroup analysis provides further evidence of potential COVID-triggered shifts in on-demand ridership intentions. The most significant drops in likelihood are observed for younger respondents (below 45), Black compared with all other racial/ethnic status, and for past users of on-demand mobility. This latter result is somewhat surprising, as riders who are younger and more experienced with on-demand travel are more likely to have been users in the past, but also more likely to reduce use during the pandemic. To conclude, we discuss the need to investigate pandemic experiences, risk attitudes, and circumstances to understand evolving mobility behavior and specific service model impacts.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies

OBJECTIVES

To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs).

METHODS

A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping).

RESULTS

SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01).

CONCLUSIONS

Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings.

KNOWLEDGE TRANSFER STATEMENT

Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Comparative admission rates and infection severity of COVID-19 among unvaccinated and vaccinated patients

Vaccination efforts have limited the burden of the pandemic caused by the coronavirus disease 2019 (COVID-19) with substantial evidence showing reduced hospitalization rates among vaccinated populations. However, few studies have explored correlations between vaccination status and inpatient COVID-19 outcomes. This observational case-control study involved a retrospective chart review of adult patients hospitalized for COVID-19 infection at a medium-sized hospital in Central Michigan between May 1, 2021 and September 30, 2021. Unadjusted analyses involved t-tests and chi-square tests followed by adjusted analyses using binary logistic and linear regression models. Of the 192 screened patients, 171 subjects met the inclusion criteria. Vaccinated patients were significantly older (71.09 vs 57.45, p < 0.001), more likely to identify as white (89.4% vs 66.9%, p = 0.026), and had a lower baseline 10-year survival rate predicted by the Charlson Comorbidity Index (42% vs 69%, p < 0.001) compared to unvaccinated patients. Common symptoms between both groups included shortness of breath (50%), malaise (23%-37%), cough (28%-32%), and fever or chills (25%). Upon matching, adjusted analysis showed significantly higher rates of remdesivir administration to unvaccinated patients (41.3% vs 13.3%, odds ratio (OR): 4.63, 90% confidence interval (CI): 1.98-11.31). Despite higher intensive care unit admission rates among unvaccinated patients (39.1% vs 23.9%, OR: 1.83, 90% CI: 0.74-4.64), this difference did not reach statistical significance. Accordingly, immunization status strongly correlates with patient demographics and differences in inpatient treatment. Larger studies are needed to further assess the vaccine's impact on inpatient outcomes outside of our community.

Willingness to receive COVID-19 booster dose and its associated factors in Ghana: A cross-sectional study

Background and Aim

The COVID-19 booster dose has been cited as an important supplement for the control of the COVID-19 pandemic due to reports of waning immunity among fully vaccinated persons. Determining factors that would affect its acceptability is necessary for initiating successful vaccination programs. In this study, we aimed to evaluate the factors associated with the acceptability of the COVID-19 booster dose in Ghana.

Methods

We conducted an online cross-sectional survey among the public. A self-administered questionnaire was used to collect information on demographic characteristics, willingness to vaccinate, perceptions toward COVID-19 vaccines, and trust in the government. Participants provided reasons and sources of advice that may affect their willingness to accept a booster dose. Using IBM SPSS and R Statistic; descriptive, univariate, and multivariate analyses were performed.

Results

Out of 812 respondents, 375 (46.2%) intended to accept the booster dose. Individuals who were males (adjusted odds ratio [aOR] 1.63, 95% confidence interval [CI] 1.07-2.48), had previously received other forms of vaccination twice (aOR 1.96, 95% CI 1.07-3.57) or in most years (aOR 2.51, 95% CI 1.38-4.57), tested positive for COVID-19 (aOR 3.46, 95% CI 1.23-10.52), have high trust in government (aOR=1.77, 95% CI: 1.15-2.74) and had positive perceptions regarding COVID-19 vaccines (OR = 14.24, 95% CI: 9.28-22.44) were more likely to accept a booster dose. Experiencing side effects from the primer dose (aOR 0.12, 95% CI 0.08-0.18) was associated with reduced acceptance. Concerns about vaccine safety and efficacy were the common reasons impeding willingness, while advice from health professionals would be the most considered.

Conclusion

Low intention to accept the booster dose which is associated with a range of factors including the perception of vaccines and trust in the government, is a cause for concern. Thus, more effort would have to be taken through education and policy interventions to increase booster vaccine acceptability.

Concerns about COVID-19 Vaccine Hesitancy among Law Enforcement Officers: Prevalence and Risk Factor Data from a Nationally Representative Sample in the United States

Scant research exists on COVID-19 vaccine hesitancy among law enforcement officers, hindering health messaging development for officers and, by extension, the communities they serve. This paper’s goal was to address this gap by providing the necessary data to better under hesitancy to guide training and policy interventions for officers. The objective was to conduct the first nationally representative survey of officers on COVID-19 vaccine hesitancy and its correlates. We collected data from February 2021 to March 2022 on officer COVID-19 vaccine hesitancy and examined their responses in terms of sociodemographic factors, health status, and job characteristics. We found that 40% of officers were COVID-19 vaccine hesitant. We found that officers with higher education, older officers, officers with more law enforcement experience, officers who received recent health checkups, and commanders (compared to line officers) were less likely to be COVID-19 vaccine hesitant. Critically, officers working in law enforcement agencies that provided masks for COVID-19 protection were less likely to be COVID-19 vaccine hesitant (compared to agencies not providing masks). Ongoing research is needed to understand how evolving attitudes and barriers toward vaccination change over time for officers and to test messaging to better align officers with health guidelines.

COVID-19 Vaccination Coverage among 42,565 Adults Amid the Spread of Omicron Variant in Beijing, China

Vaccines against coronavirus disease 2019 (COVID-19) have been in use for over two years, but studies that reflect real-world vaccination coverage and demographic determinants are lacking. Using a multistage stratified random cluster sampling method, we planned to directly explore vaccination coverage and the demographic determinants of different doses of COVID-19 vaccines in Beijing, especially in older populations. All 348 community health service centers in 16 districts were involved. We performed multivariable logistic regression analyses to identify demographic determinants of different coverage rates via adjusted odds ratios (aORs) and 95% CIs. Of the 42,565 eligible participants, the total vaccination coverage rates for ≥1 dose, ≥2 doses, ≥3 doses, and 4 doses were 93.3%, 91.6%, 84.9%, and 13.0%, respectively, but decreased to 88.1%, 85.1%, 76.2%, and 3.8% in the older population. Among all participants, younger (aOR = 1.77, 95% CI: 1.60–1.95), male (aOR = 1.15, 95% CI: 1.06–1.23), and better-educated residents (high school and technical secondary school aOR = 1.58, 95% CI: 1.43–1.74; bachelor’s degree aOR = 1.53, 95% CI: 1.37–1.70) were more likely to be fully vaccinated. People who lived in rural areas (aOR = 1.45, 95% CI: 1.31–1.60) and held the new rural cooperative health insurance (aOR = 1.37, 95% CI: 1.20–1.57) established a higher rate of full vaccination coverage. No history of chronic disease was positively associated with a higher coverage rate (aOR = 1.81, 95% CI: 1.66–1.97). Occupation also affected vaccination coverage. Demographic factors influencing the rate of vaccination with at least one or three doses were consistent with the results above. Results remained robust in a sensitivity analysis. Given the highly transmissible variants and declining antibody titers, accelerating the promotion of booster vaccination coverage, especially in high-risk groups such as the elderly, is a top priority. For all vaccine-preventable diseases, rapidly clarifying vaccine-hesitant populations, clearing barriers, and establishing a better immune barrier can effectively safeguard people’s lives and property and coordinate economic development with epidemic prevention and control.

COVID-19, travel restrictions and environmental consequences

The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage.

COVID-19 Vaccine Acceptance among University Students and Lecturers in Different Provinces of Indonesia: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic imposed a pressing global threat. Vaccines against COVID-19 are a key tool to control the ongoing pandemic. The success of COVID-19 vaccination programs will largely depend on public willingness to receive the vaccine. This study aimed to evaluate the acceptability of COVID-19 vaccines among university students and lecturers in four different provinces of Indonesia. An anonymous, cross-sectional study was conducted online among university students and lecturers in Indonesia between 23 December 2020 and 15 February 2021. Of 3433 respondents, 50.3% stated that they would accept COVID-19 vaccination, while 10.7% expressed unwillingness and 39% were not sure about receiving the vaccine. Concern regarding the side effects after COVID-19 vaccination was the main reason among the participants for not willing to receive the vaccine. Being male, associated with the health sector, having a higher monthly expenditure and having health insurance could increase the acceptability of the COVID-19 vaccine. Low trust in the government and low confidence towards vaccine safety and efficacy could hinder participants’ decision to be vaccinated. Simple, clear and fact-based information from trusted sources on a regular basis will be important for building confidence towards the COVID-19 vaccination program in Indonesia.

Understanding influencing attributes of COVID-19 vaccine preference and willingness-to-pay among Chinese and American middle-aged and elderly adults: A discrete choice experiment and propensity score matching study

Background and objective

COVID-19 has imposed burdens on public health systems globally. Owing to the urgency of vaccination, this study aimed at comparing the differences in preference and willingness to pay of COVID-19 vaccine among Chinese and American middle-aged and elderly adults.

Methods

A cross-sectional survey containing demographic questions, rating their acceptance of COVID-19 vaccination with and without recommendations from friends, family members or employers (the social cues referred to in our study), and a discrete choice experiment understanding COVID-19 vaccine preference and willingness to pay was conducted to collect data. Propensity score matching was utilized to adjust confounding factors of baseline characteristics and the relative importance of respondents' preference for each attribute and its level was estimated using a conditional logit model. Then, willingness to pay was calculated.

Results

In total, 3,494 (2,311 and 1,183 from China and the United States, respectively) completed the questionnaire, among which 3,444 questionnaires were effective. After propensity score matching, 1,604 respondents with 802 from the US and 802 from China were included. Under the influence of the social cues, Chinese respondents' vaccine acceptance decreased from 71.70 to 70.70%, while American respondents' vaccine acceptance increased from 74.69 to 75.81%. The discrete choice experiment showed that American respondents regarded the efficacy of COVID-19 vaccine as the most important attribute, whereas Chinese respondents attached the highest importance to the cost of vaccination. But overall, the COVID-19 vaccine with the higher efficacy, the milder adverse effect, the lower cost, and the longer duration will promote the preference of the public in both countries. Additionally, the public were willing to spend the most money for a reduction in COVID-19 vaccine adverse effect from moderate to very mild (37.476USD for the United States, 140.503USD for China), followed by paying for the 1% improvement in its efficacy and paying for the one-month extension of its duration.

Conclusion

Given the impact of social cues on vaccine acceptance, Chinese government should promote reasonable vaccine-related information to improve national vaccination acceptance. Meanwhile, considering the influence of COVID-19 attributes on public preference and willingness to pay, regulating the vaccine pricing, improving the efficacy of the vaccine, reducing its adverse effect, and prolonging the duration of the vaccine works will contribute to vaccine uptake.

COVID-19 Vaccination Refusal—Which Factors are Related in the Czech Republic, One of the Most Affected Countries in the World?

Objective: This study examined the willingness to get vaccinated and the factors influencing this attitude in extreme settings—in the Czech Republic (at the time of the survey, the third-worst affected country in the world).

Methods: We used national data from the general adult Czech population (N = 1,401) and measured attitudes towards vaccination, sociodemographic characteristics, government trust, knowledge about COVID-19 vaccines, personal characteristics, depression and anxiety.

Results: Respondents who were more likely to refuse the vaccine were: female, younger, living without a partner, self-employed or unemployed, living in a town, believers outside the church, and did not trust the government, obtained information about the vaccine from social media, were extroverts and depressed. Conversely, respondents who were less likely to refuse the vaccine were: pensioners, people with higher education, respondents with better real knowledge about the COVID-19 vaccines, those who obtained information about the vaccine from an expert and those who had higher scores in neuroticism.

Conclusion: This study thus offers a deeper understanding of the factors that might influence vaccine intention and subsequently the course of the COVID-19 pandemic.

COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic

AIMS

People experiencing homelessness (PEH) have been identified as being increasingly susceptible to Coronavirus disease (COVID-19), with policies enacted to test, isolate, increase hygiene practices and prioritise vaccines among this population. Here, we conduct a scoping review of the current evidence-base pertaining to the prevalence and presentation of COVID-19 in PEH, COVID-vaccine hesitancy rates and government interventions enacted within the first year of the pandemic for PEH.

MATERIALS AND METHODS

A systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 prevalence and clinical characteristics in PEH, vaccine uptake for PEH and policies enacted targeting PEH. Study qualities were assessed with The National Heart, Lung and Blood Institute's set of Study Quality.

RESULTS

Eighty-three studies were included in our final analysis. The overall prevalence of symptomatic COVID-19 infection in PEH is estimated at 35%. The most common symptoms found were cough and shortness of breath, followed by fever. Concerns regarding vaccine hesitancy amongst PEH related to thoroughness of COVID-19 vaccine clinical trials, side effects and mistrust of the government. The main strategies implemented by governments were mass testing, adaption of healthcare service provision, provision of alternative housing, encouraging personal hygiene (hand sanitation and mask wearing), and inter-organisational communication.

DISCUSSION

In our meta-analysis, 35% of PEH with a COVID-19 infection presented symptomatically; the low prevalence of symptomatic COVID-19 infection suggests widespread testing following outbreaks would be beneficial for this group of individuals. Temporary recuperation units and measures for housing stability in the pandemic, namely provision of alternative housing and stopping evictions, were found to be highly effective. High rates of vaccine hesitancy means that education and encouragement towards vaccination would be beneficial for this vulnerable population, where comorbidities are common. Finally increased focus in research should be placed on the mental health burden of COVID-19 and the pandemic on PEH moving forwards.

Acceptance and hesitancy to receive COVID-19 vaccine among university students in Egypt: a nationwide survey

BACKGROUND

The public's willingness to be vaccinated will determine the success of the COVID-19 vaccination program. The aim of this study was to identify acceptance and hesitancy to receive COVID-19 vaccine among university students in Egypt, assess their level of knowledge about COVID-19 vaccine and identify factors that influence their intention towards COVID-19 vaccination.

METHODS

A standardized and self-administered questionnaire was distributed among university students allover Egypt. The questionnaire included sociodemographic data, intention to receive COVID-19 vaccine, knowledge and beliefs about it and status of COVID-19 vaccination. Logistic regression analysis was used to determine factors associated with COVID-19 vaccine acceptancy.

RESULTS

A total of 1071 of university students were involved, with a mean age of 20.51 years (SD = 1.66) and 68.2% were females. COVID-19 vaccination acceptability rate was 69.0% while hesitancy was 20.8% and resistancy was 10.2%. Median knowledge score of 4 out of 8 (IQR = 8). The main motivation for vaccine acceptance was fear of being infected (53.6%) and desire to get back to normal life (51.0%) while the main barriers against getting vaccinated were being afraid of serious side effects. Univariate regression analysis revealed an increasing likelihood of vaccine acceptancy associated with an active lifestyle (OR 1.35, 95% CI 1.04-1.75, p = 0.025), a high knowledge score (OR 1.53, 95% CI 1.42-1.66, p < 0.001), and positive vaccine beliefs.

CONCLUSION

There is a high rate of acceptability of COVID-19 vaccination among university students. Vaccine acceptability is associated with an active lifestyle, a high knowledge score and positive vaccine beliefs. Educational campaigns and efforts aiming to raise awareness about safety and efficacy of COVID-19 vaccines need to be directed to this important population.

Bibliometric Analysis of Global Scientific Production on COVID-19 and Vaccines

This bibliometric analysis aims to analyze the global scientific production of COVID-19 and vaccines. First, a search for scientific articles was performed using the advanced query in the Web of Science™ database, more precisely in its core collection, on 18 February 2023. Data from 7754 articles were analyzed using the Bibliometrix R package and the Biblioshiny application. The evaluated articles were published mainly in 2022 (60%). The scientific journals that published the most about COVID-19 and vaccines were "Vaccines", "Vaccine" and "Human Vaccines & Immunotherapeutics". The University of Oxford was the most productive institution, with the authors of the articles mainly originating from the United States, China and the United Kingdom. The United States, despite having carried out the most significant number of collaborations, published mainly with local researchers. The 15 most cited articles and the KeyWords Plus™ evidenced the focus of the published articles on the safety and efficacy of vaccines against COVID-19, as well as on the evaluation of vaccine acceptance, more specifically on vaccine hesitancy. Research funding came primarily from US government agencies.

Assessment of acceptance, concerns and side effects towards COVID-19 vaccination among the community: A cross-sectional study from Baghdad, Iraq

Introduction

The newly developed and marketed vaccines along with concerns about vaccine safety and long-term side effects has been raised an alarming in the general population. The aim of this study was to assess the rate of acceptance, perceptions and concerns towards receiving COVID-19 vaccines and to explore the incidence of vaccines' side effects among Iraqi population in Baghdad province, Iraq.

Method

This was a descriptive, cross-sectional study conducted via direct interviews among a convenient sample size of Iraqi population using a structured validated questionnaire consisting of using 24-item questionnaire to assess acceptance, concerns and the incidence of vaccines' side effects towards receiving COVID-19 vaccines.

Results

A total of 500 participants with an average age of 27.8 ± 3.7 years were included. Majority were females (70.6%). 43.4% had a history of COVID-19, and 46% received the Pfizer BioNTech vaccine. 73.4% (P < 0.0001) agreed about the importance of receiving the vaccination to protect the community against the COVID-19.46.8% (P < 0.0001) were unsure about the adverse effects and long-term vaccine safety. 72.8% reported that transmission of COVID-19 infection to family members is the main concern for accepting vaccination. Fatigue (60%), injection site reactions (55.8%) were the most common vaccine's side effects. Young age (P = 0.001), females (P < 0.0001), and university educational (P < 0.0001) were the most significant determents for accepting vaccination.

Conclusion

This study highlights that the Iraqi population showed a considerable acceptance rate for the COVID-19 vaccines. However, vaccine safety is considered a high priority concern associated with the willingness of the population to vaccinate.

Applying two behavioral theories to predict the willingness to receive COVID-19 vaccine booster in the elderly: A cross-sectional study

BACKGROUND

The COVID-19 vaccination booster can effectively protect the elderly from infection while also lowering the risk of serious illness and death. However, barriers remain in willingness of the elderly to boost vaccination.

OBJECTIVE

Using the protection motivation theory (PMT) and the theory of planned behavior (TPB), to study the factors that influence willingness of the elderly to get the COVID-19 vaccine booster.

METHODS

The elderly who visited three randomly selected medical institutions in Nanjing's core urban region between March and April 2022 were chosen as study participants. A face-to-face survey was conducted using purposeful sampling and a self-designed questionnaire. The questionnaire contained sociodemographic characteristics, the elderly's willingness to obtain a COVID-19 vaccine booster, and psychosocial cognitive components based on the PMT and TPB. SmartPLS 3.0 was used to conduct structural equation modeling.

RESULTS

214 participants were included in the analysis. The combined model of the two behavioral theories explained the willingness to accept COVID-19 vaccine booster well with R2 of 0.490. Self-efficacy (β = 0.315) was the strongest predictor of vaccine booster willingness. Subjective norms (β = 0.160), perceived severity (β = 0.157), and perceived vulnerability (β = 0.159) also showed positive effects on vaccine booster willingness, while response cost (β = -0.143) had a negative effect on the willingness. No significant association between attitudes, response efficacy and the willingness was discovered.

CONCLUSION

The willingness of the elderly to receive the COVID-19 vaccine booster was affected by psychosocial cognitive factors. This study supports the applicability of the PMT and TPB models to interpret the willingness of the elderly in such areas.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

A Qualitative Comparative Analysis to explore the predictors of individuals' willingness towards vaccination

The emergence of COVID-19 traumatized individuals from all walks of life and while the demand for vaccines increased exponentially, the authorities seem to encounter greater challenges on their road to create herd immunity. Governments initiated numerous campaigns to influence individuals to opt for vaccination and India being a diverse country makes it difficult to understand the motivating factors for getting COVID-19 vaccination. The study aimed to explore the predictors of individuals' willingness to get vaccinated using Qualitative Comparative Analysis (QCA). After screening using the vaccine hesitancy scale, a semi-structured interview was conducted among 30 respondents from India. Crisp Set QCA was utilized to analyse the data which lead to nine conditions. A solution combination of seven conditions showed a consistency of 1 and coverage of 0.6. They included knowledge about vaccines, perceived severity of the COVID-19 virus, family and peer influence, media and health department's influence, a sense of social responsibility, trust in the authorities and vaccine efficacy. This study contributes to the relevance of QCA's use in psychological research, especially to identify predictors of willingness to immunize. The findings of this study would help in designing appropriate interventions to enhance willingness to get vaccinated.

A Time to Get Vaccinated? The Role of Time Perspective, Consideration of Future Consequences, Conspiracy Beliefs, Religious Faith, Gender, and Race on Intention to Vaccinate for COVID-19 in the United States

The present study examined the predictability of Time Perspective (TP) tendencies (i.e., Past Positive, Past Negative, Present Hedonistic, Present Fatalistic, and Future), the Balanced Time Perspective (BTP) profile, the Consideration of Future Consequences-Immediate (CFC-I) factor, the Consideration of Future Consequences-Future (CFC-F) factor, conspiracy beliefs about COVID-19 being a hoax, religious faith, gender, and race on COVID-19 vaccination intention as a dependent variable. Participants were recruited in the United States through the online platforms Prolific and Google Forms. The final sample was n = 232 (n = 99 male, n = 129 female, and n = 2 other, Mage = 31). Outcome measures included sociodemographic questions, the Zimbardo Time Perspective Inventory-short version, the Consideration of Future Consequences (CFC) ultra-short scale, the COVID-19 Conspiracy Beliefs questionnaire, and the Santa Clara Strength of Religious Faith Questionnaire-brief version. Regression analyses revealed that vaccination intention was reduced by gender identification as woman, identification as multiracial or from mixed origin, Past Positive, Deviation from a BTP profile, belief in COVID-19 as hoax, and religious faith. Conversely, intention to vaccinate against COVID-19 was increased by Past Negative, CFC-I, and CFC-F. These findings could be beneficial for knowledge transfer to behavioral interventions aimed to promote vaccination against COVID-19, health promotion campaigns, and the public health field.

A longitudinal assessment of variability in COVID-19 vaccine hesitancy and psychosocial correlates in a national United States sample

Recent evidence suggests that COVID-19 vaccine hesitancy is not static. In order to develop effective vaccine uptake interventions, we need to understand the extent to which vaccine hesitancy fluctuates and identify factors associated with both between- and within-person differences in vaccine hesitancy. The goals of the current study were to assess the extent to which COVID-19 vaccine hesitancy varied at an individual level across time and to determine whether disgust sensitivity and germ aversion were associated with between- and within-person differences in COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 1025; 516 woman; M_age = 46.34 years, SD_age = 16.56, range: 18 to 85 years; 72.6 % White) completed six weekly online surveys (March 20 - May 3, 2020). Between-person mean COVID-19 vaccine hesitancy rates were relatively stable across the six-week period (range: 38-42 %). However, there was considerable within-person variability in COVID-19 vaccine hesitancy. Approximately, 40 % of the sample changed their vaccine hesitancy at least once during the six weeks. There was a significant between-person effect for disgust sensitivity, such that greater disgust sensitivity was associated with a lower likelihood of COVID-19 vaccine hesitance. There was also a significant within-person effect for germ aversion. Participants who experienced greater germ aversion for a given week relative to their own six week average were less likely to be COVID-19 vaccine hesitant that week relative to their own six-week average. This study provides important information on rapidly changing individual variability in COVID-19 vaccine hesitancy on a weekly basis, which should be taken into consideration with any efforts to decrease vaccine hesitancy and increase vaccine uptake. Further, these findings identify-two psychological factors (disgust sensitivity and germ aversion) with malleable components that could be leveraged in developing vaccine uptake interventions.

COVID-19 vaccine hesitancy in a developing country: prevalence, explanatory factors and implications for the future

OBJECTIVES

Vaccine hesitancy is a public health challenge highlighted during the COVID-19 pandemic. This study sought to determine the prevalence and explanatory factors leading to COVID-19 vaccine hesitancy in the Jamaican population to inform vaccination strategies.

STUDY DESIGN

This was an exploratory cross-sectional study.

METHODS

An exploratory survey was distributed electronically between September and October 2021 to gather information on COVID-19 vaccination behaviour and beliefs among the Jamaican population. Data were expressed as frequencies and analysed using Chi-squared followed by multivariate logistic regressions. Significant analyses were determined at P < 0.05.

RESULTS

Of the 678 eligible responses, most were females (71.5%, n = 485), between ages 18-45 years (68.2%, n = 462), had tertiary education (83.4%, n = 564) and were employed (73.4%, n = 498), with 10.6% (n = 44) being healthcare workers. COVID-19 vaccine hesitancy was present in 29.8% (n = 202) of the survey population, mainly because of safety and efficacy concerns and a general lack of reliable information about the vaccines. The likelihood of hesitancy increased amongst respondents under 36 years (odds ratio [OR] 6.8, 95% confidence interval [CI] 3.6, 12.9), those who delayed initial acceptance of vaccines (OR 2.7, 95% CI 2.3, 3.1); parents for their children and with long waits at vaccination centres. Likelihood of hesitancy decreased for respondents over 36 years (OR 3.7, 95% CI 1.8, 7.8) and with vaccine support from pastors/religious leaders (OR 1.6, 95% CI 1.1, 2.4).

CONCLUSIONS

Vaccine hesitancy was more prevalent in younger respondents who were never exposed to the effects of vaccine-preventable diseases. Religious leaders had more influence than healthcare workers to increase vaccine uptake.

It is time to improve the acceptance of COVID-19 vaccines among people with chronic diseases: A systematic review and meta-analysis

This study aims to investigated COVID-19 vaccine acceptance among people with chronic diseases and the factors correlating with their vaccination hesitancy. The articles were searched in PubMed, Ovid, EMBASE, and web of science databases between December 2019 and October 2022. Cross-sectional studies, including the acceptance of the COVID-19 vaccine by patients with chronic diseases (≥18 years old), were included in this study. The outcomes included the proportion and 95% confidence interval (95% CI) of chronic disease patients willing to be vaccinated and the odds ratio (OR) and 95% CI of correlating factors. The source of heterogeneity was analyzed through meta-regression and subgroup analysis. We included 31 studies involving 57 875 patients with chronic disease. The overall COVID-19 vaccine acceptance among patients with chronic disease was 0.65 (95% CI, 0.59-0.72). The acceptance among the elderly patients was 0.53 (95% CI, 0.26-0.80). South America had the highest COVID-19 vaccine acceptance rate and Asia the lowest, while on a country level, the United Kingdom had the highest acceptance rate among patients with chronic diseases. People with rheumatic immune diseases had the lowest rate of COVID-19 vaccine acceptance. Concerns about vaccine safety had a statistically different effect on acceptance. Overall, the health systems ought to focus on educating specific groups of individuals on the benefits of COVID-19 vaccination and addressing safety concerns.

Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and Uptake: A Cluster Randomized Clinical Trial

IMPORTANCE

Large segments of the US population's primary health care access occurs in emergency departments (EDs). These groups have disproportionately high COVID-19 vaccine hesitancy and lower vaccine uptake.

OBJECTIVE

To determine whether provision of COVID-19 vaccine messaging platforms in EDs increases COVID-19 vaccine acceptance and uptake in unvaccinated patients.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cluster randomized clinical trial was conducted at 7 hospital EDs in 4 US cities from December 6, 2021, to July 28, 2022. Noncritically ill adult patients who had not previously received COVID-19 vaccines were enrolled.

INTERVENTIONS

A 3-pronged COVID-19 vaccine messaging platform (an English- or Spanish-language 4-minute video; a 1-page informational flyer; and a brief, scripted message from an ED physician or nurse) was delivered during patient waiting times.

MAIN OUTCOMES AND MEASURES

The 2 primary outcomes were (1) COVID-19 vaccine acceptance, assessed by survey responses in the ED, and (2) receipt of a COVID-19 vaccine within 30 days, ascertained by ED confirmation of vaccination, electronic health record review, and telephone follow-up.

RESULTS

Of the 496 participants enrolled (221 during intervention weeks and 275 during control weeks), the median (IQR) age was 39 (30-54) years, 205 (41.3%) were female, 193 (38.9%) were African American, 97 (19.6%) were Latinx, and 218 (44.0%) lacked primary care physicians. More intervention group participants, compared with control participants, stated that they would accept the vaccine in the ED (57 [25.8%] vs 33 [12.0%]; adjusted difference, 11.9 [95% CI, 4.5-19.3] percentage points; number needed to treat [NNT], 8 [95% CI, 5-22]). More intervention group participants than control participants received a COVID-19 vaccine within 30 days of their ED visit (44 [20.0%] vs 24 [8.7%]; adjusted difference, 7.9 [95% CI, 1.7-14.1] percentage points; NNT, 13 [95% CI, 7-60]). The intervention group had greater outcome effect sizes than the control group in participants who lacked a primary care physician (acceptance, 38 of 101 [37.6%] vs 16 of 117 [13.7%] [P for interaction = .004]; uptake, 31 of 101 [30.7%] vs 11 of 117 [9.4%] [P for interaction = .006]), as well as in Latinx persons (acceptance, 23 of 52 [44.2%] vs 5 of 48 [10.4%] [P for interaction = .004]; uptake, 22 of 52 [42.3%] vs 4 of 48 [8.3%] [P for interaction < .001]).

CONCLUSIONS AND RELEVANCE

Results of this cluster randomized clinical trial showed that with low NNT, implementation of COVID-19 vaccine messaging platforms in EDs leads to greater vaccine acceptance and uptake in unvaccinated ED patients. Broad implementation in EDs could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05142332.

The percentage of hesitation and factors associated with acceptance or refusal for COVID-19 vaccine: Does training about vaccines by allergist affect personal decision?

Background and aim

As the impact of coronavirus disease (COVID)-19 arises worldwide, the effect of vaccines is protecting its importance. The aim of this study was to investigate the vaccination perspectives of patients and learn how many patients were persuaded to get vaccinated with the effect of the education provided by allergists.

Materials and methods

A cross-sectional study was carried out among 200 adult patients in the outpatient clinic between February 2021 and January 2022. Patients filled out the anti-vaccination scale form and a questionnaire form developed by allergists. The training about COVID-19 vaccines has been given to the patients who did not consider getting vaccinated. The patients were called by phone and questioned whether they have been vaccinated or not, after 22 weeks.

Results

Out of 200 patients participants, 60.5% were considering getting vaccinated. Patients who did not consider getting vaccinated comprised 45.7% of women and 31% of men. While 52.4% of primary school graduates considered getting vaccinated, 75% of high school graduates and 60.8% of higher education graduates were considering getting vaccinated. Major reasons for rejecting vaccination were concerns about side effects and allergy. While the majority of women (47.2%) who did not want to get vaccinated were concerned about vaccine side effects, the majority of men (34.6%) did not want to get vaccinated because they did not trust the efficacy of the vaccine. Vaccination rates have been increased with the training we provided to our patients who did not consider getting the vaccine. 76 patients could be reached by phone and 81.6% of them were vaccinated, and 18.4% were not.

Conclusion

The vaccination rates of allergy patients who did not consider getting vaccinated were increased with the information provided by allergists. So, the allergists should give more attention for giving information and increasing the vaccination rates of covid-19.

Determination of Factors Influencing the Health Belief Model (HBM) and Adherence to Intravitreal Anti-vascular Endothelial Growth Factor (VEGF) Among Patients With Diabetic Macular Edema (DME)

Background Diabetic macular edema (DME) is becoming one of the leading causes of blindness worldwide with a significant impact on quality of life. The effectiveness of intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) therapy has been established by clinical trials and has become the treatment of choice in the majority of DME patients in reducing macular edema and improving visual acuity. Frequent drop-out and discontinuation of treatment are major issues. Lack of compliance can lead to worsening outcomes and be a burden to patients and the healthcare system. Purpose The purpose of this study is to assess multiple factors that affect adherence to IVT anti-VEGF treatment among patients with DME, including socioeconomic causes and the Health Belief Model (HBM) domains, in addition to exploring the relationship between them. Methods This cross-sectional study was conducted among DME patients in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia, from December 2020 to June 2021. We identified eligible patients using a retrospective chart review of clinical findings and optical coherence tomography (OCT) findings. Included subjects were of Malaysian nationality, aged 18 years and above, who were initiated or re-initiated IVT anti-VEGF treatment regime and on follow-up for at least six months from initial injection from January 2019 onwards. A translated and validated self-administered questionnaire was given to the respondents. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Demographics of the patient were summarized using descriptive statistics, independent sample t-test was used to compare the difference in components of the HBM questionnaire. Linear regression was further used to explore the relationship between patients' demographics and the HBM component. Results A total of 141 patients participated in this study, of whom 56.2% patients were adherent to treatment. The majority were aged 60 years and above (56.7%), male (52.5%), Malay (38.9%), and married (71.6%). There was a significant statistical difference in patients who were adherent to treatment, in terms of life entourage (p=0.004, Fisher Exact test). HBM domains that influenced adherence to treatment included perceived severity, perceived barriers, perceived benefits, cues to action, and self-efficacy (p<0.05, independent sample t-test). Further, multiple logistic regression tests on sociodemographic factors and HBM domains after eliminating confounding factors narrowed down the significant variables to perceived susceptibility (p= 0.023), perceived benefits (p< 0.001), and self-efficacy (p< 0.001). Conclusion Patients' adherence to IVT anti-VEGF is influenced by perceived susceptibility to complications from DME, perceived benefits to the treatment, and self-efficacy.

Knowledge, Attitudes and Perceptions towards COVID-19 Vaccinations: A Cross-Sectional Survey in Pakistan

Background and Objectives: Several vaccines have been approved for the prevention of the coronavirus disease, discovered on 31 December in Wuhan, China. Pakistan procured vaccines from various countries. However, the lack of knowledge and reluctance of the general population to embrace the use of the vaccines are considered to be the major determinant of the slow vaccination rate. Hence, it is necessary to evaluate the willingness of the general population about their perception of the COVID-19 vaccination. Materials and Methods: A cross sectional survey based on a self-structured questionnaire comprising 18 questions was conducted (from 21 April-21 June) on 400 Pakistani participants to evaluate their knowledge, attitude, and perception towards the COVID-19 vaccination. Chi-square independent t-test and one-way Anova including a multiple step wise linear regression were used to draw conclusions about the results. p < 0.05 was considered significant. Results: A total of 400 participants responded in the knowledge, attitude, and perception (KAP) survey of which 46.5% were female and 53.5% were male. The mean age of participants was 36.08 years. This survey showed a poor knowledge (50.5%), a fair attitude (75.1%) and a poor perception (58.1%) towards the COVID-19 vaccination. Higher mean knowledge and attitude scores were reported in the age group 21-40, females, and unmarried urban citizens. Regression analysis showed that age, education, residence, and employment status influenced the knowledge and perception score to a considerable extent. Conclusions: The findings reflect an inadequate knowledge and perception on the one hand, but a better attitude towards the COVID-19 vaccination. This knowledge attitude and perception (KAP) survey will help in better understanding the opinion of the general population towards vaccination, and will be useful for policy makers and health care authorities aiming to increase the vaccination rate.

Qualitative evaluation of reasons for healthcare professionals being unvaccinated against COVID-19

Background and Aim

The importance of immunization has increased even more during the pandemic. This study aimed to evaluate the reasons for healthcare professionals not being vaccinated against COVID-19 and to develop solutions for the causes.

Subject and Methods

This qualitative study was carried out with in-depth interviews between July 2021 and October 2021, with 32 healthcare professionals and five key people who had never been vaccinated against COVID-19.

Results

The most common reasons that healthcare professionals were not vaccinated against COVID-19 were concerns about vaccine side effects, believing that the vaccine is not effective, distrust of the vaccine content and COVID-19 treatment methods, the rapid production of the vaccine, the fact that the vaccine is produced with a new technology, thinking that the vaccine is not the definitive solution, seeing themselves as healthy and young, and the belief that they would have a mild case of the disease and recover. The main themes were COVID-19 vaccine-related reasons, individual reasons/group effects, contextual reasons, and vaccination-related general issues. The main sub-themes were vaccine production, distrust, risk perception, policies and infodemic.

Conclusion

It has been seen that the uncertainty, infodemic, and insecurity that emerged especially during the pandemic period are related to each other. As knowledge and awareness about the disease increase, there is an increase in risk perception. For this reason, social information studies should be increased and physicians should be enabled to use media tools more effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01822-7.

Understanding COVID-19 vaccine hesitancy: A cross-sectional study in Malang District, Indonesia

Introduction

Vaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia.

Methods

Data come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined.

Results and discussion

The results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195-1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026-1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027-1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998-1.040), need for chaos (OR = 1.044, 95% CI = 1.022-1.067), and populist views (OR = 1.028, 95% CI = 1.00-1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle "infodemics" are needed to address hesitancy during a new vaccine introduction program.

Model-based estimation of burden of COVID-19 with disability-adjusted life years and value of statistical life in West Bengal, India

OBJECTIVES

The COVID-19 pandemic has posed unprecedented challenges to health systems and populations, particularly in India. Comprehensive, population-level studies of the burden of disease could inform planning, preparedness and policy, but are lacking in India. In West Bengal, India, we conducted a detailed analysis of the burden caused by COVID-19 from its onset to 7 January 2022.

SETTING

Open-access, population-level and administrative data sets for West Bengal were used.

PRIMARY AND SECONDARY OUTCOME MEASURES

Disability-adjusted life years (DALYs), years of potential productive life lost (YPPLL), cost of productivity lost (CPL: premature mortality and absenteeism), years of potential life lost (YPLL), premature years of potential life lost, working years of potential life lost (WYPLL) and value of statistical life (VSL) were estimated across scenarios (21 for DALY and 3 each for YPLL and VSL) to evaluate the effects of different factors.

RESULTS

COVID-19 had a higher impact on the elderly population with 90.2% of deaths arising from people aged above 45. In males and females, respectively, DALYs were 190 568.1 and 117 310.0 years, YPPLL of the productive population was 28 714.7 and 16 355.4 years, CPL due to premature mortality was INR3 198 259 615.6 and INR583 397 335.1 and CPL due to morbidity was INR2 505 568 048.4 and INR763 720 886.1. For males and females, YPLL ranged from 189 103.2 to 272 787.5 years and 117 925.5 to 169 712.0 years for lower to higher age limits, and WYPLL was 54 333.9 and 30 942.2 years. VSL (INR million) for the lower, midpoint and upper life expectancies was 883 330.8; 882 936.4; and 880 631.3, respectively. Vaccination was associated with reduced mortality.

CONCLUSIONS

The losses incurred due to COVID-19 in terms of the computed estimates in West Bengal revealed a disproportionately higher impact on the elderly and males. Analysis of various age-gender subgroups enhances localised and targeted policymaking to minimise the losses for future pandemics.

Understanding the Impact of General Vaccine Attitudes on the Intent for Early COVID-19 Vaccination

Despite relatively high rates of population spread, morbidity and mortality, the adoption of COVID-19 vaccines among the eligible populations was relatively slow. Some of the reasons for vaccination hesitancy and refusals have been attributed to unique aspects of this pandemic, including attitudes toward COVID-19 vaccines. However, little attention has been paid to the role of underlying vaccine beliefs in the likelihood of early vaccine adoption for COVID-19. This study provides a more comprehensive assessment of factors influencing willingness to get an early vaccination, and the relative contribution of general vaccine attitudes, compared to demographics, perceived threat and institutional trust. Monthly national surveys were conducted between June and November 2020 using a national consumer panel of U.S. adults (n = 6185). By late November, only 24% of respondents said they were very likely to get a Food and Drug Administration (FDA)-approved COVID-19 vaccine as soon as it became available. While COVID-19 risk perceptions, confidence and trust in key institutions and information sources, and some demographic variables, were predictive of early vaccination intent, general beliefs regarding vaccines played a significant role, even compared to demographics, perceived risk and institutional trust. This lesson from the COVID-19 experience could help inform public health communications in future epidemics.

Communicating with Patients about COVID-19 Vaccination: A Qualitative Study on Vaccinators in Tuscany Region, Italy

The rapid development of the vaccine and the infodemia have challenged communication about COVID-19 vaccines. This study aims to characterize-through the experience of vaccinators-the challenges faced during COVID-19 vaccination consultations and the communication strategies adopted. A qualitative study was conducted on COVID-19 vaccinators in Tuscany, Italy. Face-to-face interviews were conducted and examined by thematic analysis. In total, 30 vaccinators were interviewed. Four main themes emerged. The first highlighted distinct profiles of users' attitudes toward COVID-19 vaccination. Barriers and promoters of vaccine uptake emerged in the second theme: concerns over the vaccine, excessive exposure to information, and a lack of clear guidance from institutions were the main factors behind hesitancy. The third theme highlighted users' information-seeking behaviors; vaccinators observed that users ideologically opposed to the vaccine (IOV) unconsciously seek information that confirms their theories. The last theme comprised communication strategies for dealing with hesitancy. Empathy, first-hand examples, transparency, and tailored communication style appear to be effective in building vaccine trust. Lastly, the impossibility of developing a decision-making partnership with IOVs was noticed. These findings may help to better characterize public attitudes toward COVID-19 vaccination and highlight key communication principles and strategies to foster vaccine confidence.

Patients with IBD have a more cautious attitude towards COVID-19 vaccination

Background

To understand the awareness of COVID-19 vaccine, the willingness to vaccinate and the influencing factors of willingness to vaccinate in inflammatory bowel disease (IBD) patients.

Methods

The online questionnaire was distributed to conduct a survey to analyze and evaluate the willingness, awareness and trust in vaccines of IBD patients. Bivariate analyses and logistic regression models were used to analysis influencing factors.

Results

We sent the questionnaire to the WeChat group for patient management and 304 patients responded, out of which 16 respondents had to be excluded and 288 respondents were included for the analysis. Among them, 209 patients vaccinated with COVID-19 vaccine. Among the non-vaccinated 79 patients, the main reasons for their concerns were afraid of vaccination aggravating IBD and fear of adverse effects. Our results showed that IBD patients with long disease duration were more willing to receive COVID-19 vaccination (P<0.05). We also observed that a high perception of benefits and cues to action to receive the vaccine were the two most important constructs affecting a definite intention for COVID-19 vaccination (P<0.05).

Conclusions

Patients with IBD have a more cautious attitude towards COVID-19 vaccination, which may lead to a higher rate of vaccine hesitancy. Further efforts should be made to protect patients with IBD from COVID-19 infections and achieve adequate vaccination coverage.

Willingness to receive the COVID-19 vaccine among HIV positive men who have sex with men in China: a cross-sectional study

BACKGROUND

People living with HIV(PLWH) are deemed more vulnerable to the SARS-CoV-2 infection than the uninfected population. Vaccination is an effective measure for COVID-19 control, yet, little knowledge exists about the willingness of men who have sex with men (MSM) living with HIV in China to be vaccinated.

METHODS

This cross-sectional study evaluated the willingness of MSM living with HIV to receive COVID-19 vaccination in six cities of Guangdong, China, from July to September 2020. Factors associated with willingness to receive COVID-19 vaccination using multivariable logistic regression.

RESULTS

In total, we recruited 944 HIV-positive MSM with a mean age of 29.2 ± 7.7 years. Of all participants, 92.4% of them were willing to receive the COVID-19 vaccine. Participants who were separated, divorced, or widowed (adjusted OR: 5.29, 95%CI: 1.02-27.48), had an annual income higher than 9,000 USD (adjusted OR: 1.70, 95%CI: 1.01-2.86), had ever taken an HIV self-test (adjusted OR: 1.78, 95%CI: 1.07-2.95), had ever disclosed sexual orientation to a doctor/nurse (adjusted OR: 3.16, 95%CI: 1.33-7.50), had ever disclosed sexual orientation to others besides their male partners (adjusted OR: 2.18, 95%CI: 1.29-3.69) were more willing to receive the vaccine. Sex with a female partner in the past six months decreased the likelihood of willingness to receive the vaccine (adjusted OR: 0.40, 95%CI: 0.17-0.95). Economic burden, worry that my health condition could not bear the risk of receiving COVID-19 vaccines, and concern that the vaccination would affect the immune status and antiretroviral therapy were the main reasons for unwillingness to receive vaccination.

CONCLUSION

Our study showed that HIV-positive MSM had a high willingness to receive the COVID-19 vaccination. Targeted interventions such as health education should be conducted among MSM with HIV infection to enhance COVID-19 vaccine uptake.

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

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