Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic

Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature

Background

Vaccine hesitancy continues to limit global efforts in combatting the COVID-19 pandemic. Emerging research demonstrates the role of social media in disseminating information and potentially influencing people's attitudes towards public health campaigns. This systematic review sought to synthesize the current evidence regarding the potential role of social media in shaping COVID-19 vaccination attitudes, and to explore its potential for shaping public health interventions to address the issue of vaccine hesitancy.

Methods

We performed a systematic review of the studies published from inception to 13 of March2022 by searching PubMed, Web of Science, Embase, PsychNET, Scopus, CINAHL, and MEDLINE. Studies that reported outcomes related to coronavirus disease 2019 (COVID-19) vaccine (attitudes, opinion, etc.) gathered from the social media platforms, and those analyzing the relationship between social media use and COVID-19 hesitancy/acceptance were included. Studies that reported no outcome of interest or analyzed data from sources other than social media (websites, newspapers, etc.) will be excluded. The Newcastle Ottawa Scale (NOS) was used to assess the quality of all cross-sectional studies included in this review. This study is registered with PROSPERO (CRD42021283219).

Findings

Of the 2539 records identified, a total of 156 articles fully met the inclusion criteria. Overall, the quality of the cross-sectional studies was moderate - 2 studies received 10 stars, 5 studies received 9 stars, 9 studies were evaluated with 8, 12 studies with 7,16 studies with 6, 11 studies with 5, and 6 studies with 4 stars. The included studies were categorized into four categories. Cross-sectional studies reporting the association between reliance on social media and vaccine intentions mainly observed a negative relationship. Studies that performed thematic analyses of extracted social media data, mainly observed a domination of vaccine hesitant topics. Studies that explored the degree of polarization of specific social media contents related to COVID-19 vaccines observed a similar degree of content for both positive and negative tone posted on different social media platforms. Finally, studies that explored the fluctuations of vaccination attitudes/opinions gathered from social media identified specific events as significant cofactors that affect and shape vaccination intentions of individuals.

Interpretation

This thorough examination of the various roles social media can play in disseminating information to the public, as well as how individuals behave on social media in the context of public health events, articulates the potential of social media as a platform of public health intervention to address vaccine hesitancy.

Funding

None.

Correlates of COVID-19 vaccination intentions: Attitudes, institutional trust, fear, conspiracy beliefs, and vaccine skepticism

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18-74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated.

COVID-19 vaccine hesitancy in Addis Ababa, Ethiopia: a mixed-method study

OBJECTIVE

Data on COVID-19 vaccine hesitancy is limited in Ethiopia and other parts of Africa. Therefore, the aim of this study was to determine the level of COVID-19 vaccine hesitancy and its associated factors in Addis Ababa, Ethiopia.

DESIGN

A community-based concurrent mixed-method study.

SETTING

In a community setting.

PARTICIPANTS

Adult residents (n=422) of Akaki Kality subcity who were recruited by a two stage sampling technique and 24 adults who were selected purposively were included for the quantitative and qualitative part of the study respectively.

OUTCOME MEASURES

Data were collected by face-to-face interview using a semistructured questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified by multivariable binary logistic regression model.

RESULTS

One out five (19.1%, 95% CI 15.3% to 24.6%) participants were not willing to get vaccinated. In the multivariable analysis, vaccine hesitancy was significantly associated with being female (aOR=1.97; 95% CI 1.10 to 3.89), having negative attitude towards COVID-19 and its preventive measures (aOR=1.75; 95% CI 1.08 to 3.02), and primary information source being social media (internet) (aOR=3.59; 95% CI 1.75 to 7.37). Study participants have predominantly stated that they did not have enough information about the vaccine, feared it would not be effective or have too many side effects, and reflected their uncertainty towards the quality of the vaccine.

CONCLUSIONS

A considerable proportion of the people in Addis Ababa have concerns on COVID-19 vaccines and unwilling to accept them. This was due to the misconceptions, negative attitudes and use of social media as their primary source of information. Providing the community with health education and consistent efforts to enhance the prevention measures are important, particularly using different medias including social media.

Leaving No One Behind: Interventions and Outcomes of the COVID-19 Vaccine Maximising Uptake Programme

The devastating impact of COVID-19 on individuals and communities has accelerated the development of vaccines and the deployment of ambitious vaccination programmes to reduce the risks of infection, infection transmission and symptom severity. However, many people delay or refuse to get vaccinated against COVID-19, for many complex reasons. Vaccination programmes that are tailored to address individual and communities' COVID-19 concerns can improve vaccine uptake rates and help achieve the required herd-immunity threshold. The Maximising Uptake Programme has led to the vaccination of 7979 people from February-August 2021 in the South West of England, UK, who are at high risk of severe illness from COVID-19 and/or may not access the COVID-19 vaccines through mass vaccination centres and general practices. These include: people experiencing homelessness; non-English-speaking people; people from minority ethnic groups; refugees and asylum seekers; Gypsy, Roma, Travelers and boat people; and those who are less able to access vaccination centres, such as people with learning difficulties, serious mental illness, drug and alcohol dependence, people with physical and sensory impairment, and people with dementia. Outreach work coupled with a targeted communication and engagement campaign, co-designed with community leaders and influencers, have led to significant engagement and COVID-19 vaccine uptake among the target populations.

What Is the Support for Conspiracy Beliefs About COVID-19 Vaccines in Latin America? A Prospective Exploratory Study in 13 Countries

Conspiracy theories about COVID-19 began to emerge immediately after the first news about the disease and threaten to prolong the negative impact of the COVID-19 pandemic by limiting people's willingness of receiving a life-saving vaccine. In this context, this study aimed to explore the variation of conspiracy beliefs regarding COVID-19 and the vaccine against it in 5779 people living in 13 Latin American countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela) according to sociodemographic variables such as gender, age, educational level and source of information about COVID-19. The study was conducted during the COVID-19 pandemic between September 15 and October 25, 2021. The Spanish-language COVID-19 Vaccine Conspiracy Beliefs Scale (ECCV-COVID) and a sociodemographic survey were used. The results indicate that, in most countries, women, people with a lower educational level and those who receive information about the vaccine and COVID-19 from family/friends are more supportive of conspiracy ideas regarding the COVID-19 vaccine. In the case of age, the results vary by country. The analysis of the responses to each of the questions of the ECCV-COVID reveals that, in general, the countries evaluated are mostly in some degree of disagreement or indecision regarding conspiratorial beliefs about COVID-19 vaccines. The findings could help open further study which could support prevention and treatment efforts during the COVID-19 pandemic.

Antecedents and consequences of COVID-19 conspiracy beliefs: A systematic review

RATIONALE

Belief in COVID-19 conspiracy theories can have severe consequences; it is therefore crucial to understand this phenomenon, in its similarities with general conspiracy belief, but also in how it is context-dependent.

OBJECTIVE

The aim of this systematic review is to provide a comprehensive overview of the available research on COVID-19 conspiracy beliefs and to synthesise this research to make it widely accessible.

METHODS

We present a synthesis of COVID-19 conspiracy belief research from 85 international articles, identified and appraised through a systematic review, in line with contemporary protocols and guidelines for systematic reviews.

RESULTS

We identify a number of potential antecedents of COVID-19 conspiracy beliefs (individual differences, personality traits, demographic variables, attitudes, thinking styles and biases, group identity, trust in authorities, and social media use), their consequences (protective behaviours, self-centred and misguided behaviours such as hoarding and pseudoscientific health practices, vaccination intentions, psychological wellbeing, and other negative social consequences such as discrimination and violence), and the effect sizes of their relations with the conspiracy beliefs.

CONCLUSIONS

We conclude that understanding both the potential antecedents and consequences of conspiracy beliefs and how they are context-dependent is highly important to tackle them, whether in the COVID-19 pandemic or future threats, such as that of climate change.

Barriers and facilitators of willingness to vaccinate against COVID-19: Role of prosociality, authoritarianism and conspiracy mentality. A four-wave longitudinal study

AIM

We investigated longitudinal relations between individual willingness to undergo vaccination against COVID-19 and three social factors: conspiracy mentality, prosociality, and authoritarianism.

METHOD

This longitudinal study comprised four measurement points. The first wave sample included 1130 responses and was representative of the Polish population in terms of gender, age, and place of residence. Analyses were performed using random intercept cross-lagged panel models.

RESULTS

We observed bidirectional positive cross-lagged relationships between prosociality and willingness to undergo vaccination in the first three waves of measurement. Authoritarianism and conspiracy mentality translated into a lower willingness to vaccinate between the third and fourth points of measurement when the vaccination became a near-term possibility.

CONCLUSIONS

Eliciting prosocial motivation to vaccinate can be paramount in overcoming vaccine hesitancy. Because conspiracy thinking may be a crucial barrier to willingness to be vaccinated, it is critical to focus on planning interventions and campaigns undermining conspiracy theories about COVID-19.

Trust in physicians and trust in government predict COVID-19 vaccine uptake

OBJECTIVE

We consider how trust in government, trust in physicians, and interpersonal trust affect the likelihood of COVID-19 vaccine uptake.

METHODS

A survey of 3057 registered South Dakota voters was fielded in April 2021 that measured COVID-19 vaccine uptake, three aspects of trust, and several other factors related to vaccine hesitancy. Logistic regression was utilized to analyze the responses.

RESULTS

We found positive, statistically significant, and substantively impactful effects for trust in government and trust in physicians on the likelihood of COVID-19 vaccine uptake, and null results for interpersonal trust.

CONCLUSIONS

Our findings provide a more nuanced understanding of the relationship between trust and COVID-19 vaccine uptake, and suggest that public health official as well as physicians should strive to increase the public's trust in the medical community.

The Psychological Experience of COVID-19 Vaccination and Its Impact on the Willingness to Receive Booster Vaccines among the Chinese Population: Evidence from a National Cross-Sectional Study

The purpose of this study was to assess the psychological experience of COVID-19 basic vaccination, the willingness to receive booster vaccines, and to determine their relationships among Chinese people. Between 6 August 2021 and 9 August 2021, a research firm performed a national cross-sectional online survey among Chinese individuals (aged over 18), using the snowball sampling approach, with 26,755 participants. Factor analysis and binary logistic regression were used to evaluate the existing associations. The overall COVID-19 vaccination psychological experience score of the participants was 25.83 (25.78~25.89; scores ranged from 7–35). A total of 93.83% (95%CI = 93.54~94.12) of respondents indicated a willingness to receive booster vaccines. After classifying psychological experiences associated with COVID-19 vaccination into positive and negative experiences and adjusting for confounding factors, for the former, the willingness to receive booster vaccines for participants with the highest scores of 13–15 was 3.933 times higher (OR = 3.933, 95%CI = 3.176~4.871) than participants who obtained scores of 3–9, and for the latter, the willingness to receive booster vaccines for participants with the highest scores of 19–20 was 8.871 times higher (OR = 8.871, 95%CI = 6.240~12.612) than participants who obtained scores of 4–13. Our study suggests that a good psychological experience with vaccination is positively associated with an increased willingness to receive booster vaccines.

COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination

Background

The hesitancy in taking the COVID-19 vaccine is a global challenge. The need to identify predictors of COVID-19 vaccine reluctance is critical. Our objectives were to evaluate sociodemographic, psychological, and behavioral factors, as well as attitudes and beliefs that influence COVID-19 vaccination hesitancy in the general population of Italy.

Methods

A total of 2,015 people were assessed in two waves (March, April and May, 2021). Participants were divided into three groups: (1) individuals who accepted the vaccination (“accepters”); (2) individuals who refused the vaccination (“rejecters”); and (3) individuals who were uncertain about their attitudes toward the vaccination (“fence sitters”). Group comparisons were performed using ANOVA, the Kruskal-Wallis test and chi-square tests. The strength of the association between the groups and the participants' characteristics was analyzed using a series of multinomial logistic regression models with bootstrap internal validation (one for each factor).

Results

The “fence sitters” group, when compared to the others, included individuals of younger age, lower educational level, and worsening economic situation in the previous 3 months. After controlling for sociodemographic factors, the following features emerged as the main risk factors for being “fence sitters” (compared with vaccine “accepters”): reporting lower levels of protective behaviors, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and higher conspirative mentality. Higher levels of COVID-19 perceived risk, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and protective behaviors were associated with a higher likelihood of becoming “fence sitters” rather than vaccine “rejecters.”

Conclusions

The “fence sitters” profile revealed by this study is intriguing and should be the focus of public programmes aimed at improving adherence to the COVID-19 vaccination campaign.

SARS-CoV-2 Vaccine Acceptance Disparity Among Israeli Defense Forces Personnel

INTRODUCTION

Promoting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine acceptance and uptake became necessary to achieve a high vaccination rate and subsequently herd immunity. Although the Israeli population has been largely acceptant of the SARS-CoV-2 vaccine, vaccine hesitancy has remained a major concern, especially in younger adults. We hypothesized that young adults who refused SARS-CoV-2 vaccination differed from those who have been adherent and could be characterized. Studying this specific population and recognizing individuals within this group who might be more probable to refuse vaccination can enable to target measures to further promote vaccination acceptance.

METHODS

We conducted a cross-sectional comparison in a study population comprised of 17,435 Israeli Defense Forces (IDF) personnel who were SARS-CoV-2 vaccine eligible. This group included 14,834 vaccinated and 2,601 nonvaccinated individuals. Patient characteristics including occupational parameters, demographic features, psychotechnical grading (an intelligence assessment score), education level, and medical background were collected.

RESULTS

The median age was 20.57 years and almost 80% were males. At the time of data collection, most individuals (85.1%, n = 14,834) have been vaccinated. Officers and noncommissioned officers were more likely to be vaccinated compared with regular soldiers (96%, and 90.2% vs. 83.3% respectively, P < .001), as well as combat battalions stationed personnel compared to their peers in rear and administrative units (89.4% vs. 78.4%, P < .001). Socioeconomic clusters were also associated with vaccination adherence, with 92.9% vs. 79.5% vaccination rates in the highest and lowest clusters, respectively (P < .001). Younger age, no previous immigration status, higher education level, and higher psychotechnical grades were also found associated with an increased likelihood of being vaccinated (P < .001).

CONCLUSIONS

In a large cohort of enlisted IDF personnel, disparity in SARS-CoV-2 vaccine adherence was found to be related to multiple socioeconomic, educational, and military service-related variables. Although some differences were substantial, others were small and of questionable public health significance. Acknowledging these differences may enable community leaders, health care providers, and administrators to target specific populations in order to further promote SARS-CoV-2 vaccination acceptance.

Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies

Ethnic minority communities in the UK have been disproportionately affected by the pandemic, with increased risks of infection, severe disease, and death. Hesitancy around the COVID-19 vaccine may be contributing to disparities in vaccine delivery to ethnic minority communities. This systematic review aims to strengthen understanding of COVID-19 vaccine concerns among ethnic minorities in the UK. Five databases were searched in February 2022, yielding 24 peer-reviewed studies reporting on vaccine hesitancy or acceptance in ethnic minority groups. Data were extracted using a standardised form, and quality assessment was carried out using the Standard Quality Criteria. There were three key themes: (1). Prevalence of vaccine hesitancy; (2). Reasons for vaccine hesitancy and acceptance; and (3). Recommendations to address vaccine concerns. Vaccine hesitancy, which was more common among some ethnic minority groups, is a complex phenomenon, driven by misinformation, mistrust, concerns about safety and efficacy, and structural and systemic inequities. Community engagement and tailored communication may help to address vaccine concerns. Robust data disaggregated by ethnicities are needed to better understand barriers and facilitators for COVID-19 vaccine delivery in ethnic minority communities. Strategies to address structural disadvantage need to be inclusive, comprehensive, and behaviorally informed and foster confidence in healthcare systems and governments. Community leaders and health care practitioners may prove to be the most important agents in creating an environment of trust within ethnic minority groups.

The relationship of socio-demographic factors and patient attitudes to connected health technologies: A survey of stroke survivors

More evidence is needed on technology implementation for remote monitoring and self-management across the various settings relevant to chronic conditions. This paper describes the findings of a survey designed to explore the relevance of socio-demographic factors to attitudes towards connected health technologies in a community of patients. Stroke survivors living in the UK were invited to answer questions about themselves and about their attitudes to a prototype remote monitoring and self-management app developed around their preferences. Eighty (80) responses were received and analysed, with limitations and results presented in full. Socio-demographic factors were not found to be associated with variations in participants' willingness to use the system and attitudes to data sharing. Individuals' levels of interest in relevant technology was suggested as a more important determinant of attitudes. These observations run against the grain of most relevant literature to date, and tend to underline the importance of prioritising patient-centred participatory research in efforts to advance connected health technologies.

Motivational Factors to Receive the COVID-19 Vaccine in the United Arab Emirates: A Cross-Sectional Study

The United Arab Emirates has been very successful in its vaccination campaign for the COVID-19 injection, and vaccine hesitancy is not currently a major concern. Nevertheless, the motivations of residents in the UAE to receive the COVID-19 vaccine are varied. In this study with 426 vaccinated participants, 55% expressed health motivations to receive the vaccine, whereas 45% expressed non-health motivations. Nationality was a predictive factor in motivation, as expatriates from South Asian countries expressed the lowest motivation to get the vaccine on the basis of intrinsic health reasons, followed by expatriates from Arab countries, Emiratis, and expatriates from the rest of the world. The same nationality pattern was observed in vaccine readiness and vaccine knowledge. Both of these variables had a correlation with intrinsic health motivation in receiving the vaccine. No significant difference across nationalities was observed regarding vaccine conspiracy beliefs, and this variable only had a weak negative correlation with motivations to receive the vaccine.

Trust and experiences of National Health Service healthcare do not fully explain demographic disparities in coronavirus vaccination uptake in the UK: a cross-sectional study

OBJECTIVE

To test whether demographic variation in vaccine hesitancy can be explained by trust and healthcare experiences.

DESIGN

Cross-sectional study.

SETTING

Data collected online in April 2021.

PARTICIPANTS

Data were collected from 4885 UK resident adults, of whom 3223 had received the invitation to be vaccinated against the novel coronavirus and could therefore be included in the study. 1629 included participants identified as female and 1594 as male. 234 identified as belonging to other than white ethnic groups, while 2967 identified as belonging to white ethnic groups.

PRIMARY AND SECONDARY OUTCOME MEASURES

Uptake of coronavirus vaccination.

RESULTS

Membership of an other than white ethnic group (adjusted OR (AOR)=0.53, 95% CI 0.35 to 0.84, p=0.005) and age (AOR=1.61, 95% CI 1.39 to 1.87, p<0.001 for a 1 SD change from the mean) were the only statistically significant demographic predictors of vaccine uptake. After controls for National Health Service (NHS) healthcare experiences and trust in government, scientists and medical professionals, the effect associated with membership of an other than white ethnic group appears more marginal (AOR=0.61, 95% CI 0.38 to 1.01, p=0.046), while the effect associated with age remains virtually unchanged. Exploratory analysis suggests that NHS healthcare experiences mediate 24% (95% CI 8% to 100%, p=0.024) of the association between ethnicity and uptake, while trust mediates 94% (95% CI 56% to 100%, p=0.001) of the association between NHS healthcare experiences and uptake.

CONCLUSIONS

Members of other than white ethnic groups report inferior NHS healthcare experiences, potentially explaining their lower reported trust in government, scientists and medical professionals. However, this does not fully explain the ethnic gap in coronavirus vaccination uptake.

Public Policy Measures to Increase Anti-SARS-CoV-2 Vaccination Rate in Russia

The total vaccination rate remains relatively low in Russia as of March 2022 (around 55%, with around 20% in some regions). In the paper, we study the reasons for it. We communicate the results of our survey aimed at detecting reasons for the relatively low anti-SARS-CoV-2 vaccination rate in Russia (47.1% as of mid-January 2022) and suggest potential measures to increase the level of confidence in the Russian vaccination campaign. A total of 14,310 users exhibited interest to participate in the research (16.84% of the total number of invitations sent in the Russian social network VKontakte). After the sample set repair, only 5822 (40.68% of those who agreed to participate) responses were suitable for the research, and they composed the final set. The age range of the respondents was 16-51 years old (y.o.) with a mean of 29.1 ± 10.6 y.o. The proportion of the female gender in responses was 44.23%. A total of 2454 persons (42.15%) expressed their hesitant, cautious, or negative attitude towards vaccine uptake. Of the 2454 persons with cautious attitude towards vaccination, only 928 (37.82%) were concerned about the quality of the Russian vaccines. A total of 1323 individuals (53.91%) supported one or more conspiracy beliefs. A total of 5064 (86.98% of the whole set) showed cautious or negative attitude towards the planned introduction of a nationwide system of vaccination certification/verification based on QR codes. The main social factors that hinder the Russian vaccination campaign are: vexation over the lack of desire of officials to receive feedback from the general population regarding vaccination, wide support for conspiracy beliefs, and controversy over the QR code-based digital system. To elevate the vaccination rate in Russia, the following steps may be taken: social encouragement of those who support vaccination, increase in transparency of the vaccination campaign, acceptance of both digital and paper vaccination certificates, increase in participation of society in vaccination-related discussions, public disclosure of vaccine composition, and avoidance of excessive digitalization of data in the vaccination campaign.

COVID-19 Vaccine Hesitancy: The Role of Information Sources and Beliefs in Dutch Adults

COVID-19 vaccine hesitancy may be regarded as a new pandemic hindering the elimination of or coping with COVID-19. This study assessed reasons for COVID-19 vaccine hesitancy using the I-Change Model (ICM) by considering the role of informational and psychosocial factors. A cross-sectional online survey using a convenience sample was conducted among Dutch adults (n = 240). The questionnaire assessed information factors, predisposing factors, awareness factors, motivational factors, preparatory actions, and vaccination intention. Vaccine hesitant participants (n = 58, 24%) had lower levels of education, more often paid work, and tended to have a religion other than Catholicism. They used written media less often and tended to visit websites of public health organizations less often, but used messaging services like WhatsApp more frequently. All participants had neutral intentions towards checking information credibility. Vaccine hesitant respondents had less knowledge about vaccination, lower perceived severity of getting sick and dying of COVID-19, and reported fewer exposures to cues about the advantages of COVID-19 vaccination. They were less convinced of the emotional and rational advantages of COVID-19 vaccination and expressed more negative feelings about it. They also reported more negative social norms concerning COVID-19 vaccination, and lower self-efficacy to get vaccinated and to cope with potential side-effects. The regression model explained 58% of the variance in vaccination intention. The results suggest that strategies are needed to: 1. Reduce fake news and stimulate information checking to foster well-informed decision-making; 2. Target both rational and emotional consequences of COVID-19, in addition to strategies for optimizing levels of knowledge. Campaigns should acknowledge the perceptions of the emotional disadvantages and increase perceptions of emotional advantages of COVID-19 vaccinations, such as reducing feelings of regret, and increasing feelings of freedom and reassurance.

Longitudinal changes in COVID-19 vaccination intent among South African adults: evidence from the NIDS-CRAM panel survey, February to May 2021

Background

COVID-19 vaccine hesitancy has threatened the ability of many countries worldwide to contain the pandemic. Given the severe impact of the pandemic in South Africa and disruptions to the roll-out of the vaccine in early 2021, slower-than-expected uptake is a pressing public health challenge in the country. We examined longitudinal changes in COVID-19 vaccination intent among South African adults, as well as determinants of intent to receive a vaccine.

Methods

We used longitudinal data from Wave 4 (February/March 2021) and Wave 5 (April/May 2021) of the National Income Dynamics Study: Coronavirus Rapid Mobile Survey (NIDS-CRAM), a national and broadly representative panel survey of adults in South Africa. We conducted cross-sectional analyses on aggregate and between-group variation in vaccination intent, examined individual-level changes between waves, and modeled demographic predictors of intent.

Results

We analysed data for 5629 (Wave 4; 48% male, mean age 41.5 years) and 5862 (Wave 5; 48% male, mean age 41.6 years) respondents. Willingness to get a COVID-19 vaccine significantly increased from 70.8% (95% CI: 68.5–73.1) in Wave 4 to 76.1% (95% CI: 74.2–77.8) in Wave 5. Individual-level analyses indicated that only 6.6% of respondents remained strongly hesitant between survey waves. Although respondents aged 18–24 years were 8.5 percentage points more likely to report hesitancy, hesitant respondents in this group were 5.6 percentage points more likely to change their minds by Wave 5. Concerns about rushed testing and safety of the vaccines were frequent and strongly-held reasons for hesitancy.

Conclusions

Willingness to receive a COVID-19 vaccine has increased among adults in South Africa, and those who were entrenched in their reluctance make up a small proportion of the country’s population. Younger adults, those in formal housing, and those who trusted COVID-19 information on social media were more likely to be hesitant. Given that stated vaccination intent may not translate into behaviour, our finding that three-quarters of the population were willing to accept the vaccine may reflect an upper bound. Vaccination promotion campaigns should continue to frame vaccine acceptance as the norm and tailor strategies to different demographic groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12826-5.

Preparing for the Next Pandemic to Protect Public Mental Health: What Have We Learned from COVID-19?

The COVID-19 pandemic exerted an extraordinary impact on public mental health to an extent not yet fully understood. Risk perception shaped psychological and behavioral responses, including experiences of distress, psychiatric disorders, and engagement in pandemic-related health behaviors. COVID-19 created unique aspects of evolving risk with various communities disproportionately impacted. The unique nature and duration of the pandemic required public-private partnerships that leveraged and adapted promising practices to promote essential elements that foster well-being after disasters. Early findings are reviewed, and further research will inform on best practices for protecting public mental health during future pandemics.

To vax or not to vax: Predictors of anti-vax attitudes and COVID-19 vaccine hesitancy prior to widespread vaccine availability

The novel coronavirus (COVID-19) is a highly contagious disease responsible for millions of deaths worldwide. Effective vaccines against COVID-19 are now available, however, an extreme form of vaccine hesitancy known as anti-vax attitudes challenge vaccine acceptance and distribution efforts. To understand these anti-vax attitudes and their associated psychological characteristics, we examined several predictors of vaccine hesitancy for COVID-19 and anti-vax attitudes generally. We surveyed 1004 adults (M = 47.0 years, SD = 17.1 years, range 18-98 years) in September-October 2020 across the United States (51% female, 49% male; 76.5% White, 23.5% non-White), prior to widespread availability of the COVID-19 vaccines. Attitudes toward vaccinations were influenced by a variety of factors, especially political attitudes. We should therefore anticipate and attempt to mitigate these challenges to achieving widespread vaccination to reduce the spread of COVID-19 and other communicable diseases.

Exploring the Role of Trust in Scientists to Explain Health-Related Behaviors in Response to the COVID-19 Pandemic

The devastating COVID-19 pandemic has cast a light on the question of why trust in scientists is important. This mixed-method study aimed to explore the study participants' trust in scientists about getting the COVID-19 vaccine. It also aimed to reveal which key sources of information participants followed about the pandemic. Participants' health-related behaviors and justifications for their behaviors as a response to the pandemic were also explored to understand how trust in scientists and sources of information played a role in the fight against COVID-19. The responses of 1233 participants across Turkey were analyzed. The findings indicated that trust in scientists and compliance with the scientists' suggested behaviors among the participants were quite high. It was also revealed that, for both trust and non-trust groups, participants questioned the reliability of information and the sources. Participants justified their behaviors mainly by referring to policies, e.g., masks, distance, and hygiene, developed and implemented with the collaboration of government, scientists, and the World Health Organization. Moreover, trust issues regarding scientists, government authorities, or other citizens were mentioned in participants' justifications. The current study also shed light on the importance of building trust through an open and healthy dialogue among scientists, government authorities, and the public to overcome the COVID-19 pandemic. The study highlighted the need for scientifically informed citizens to deal with the problems, i.e., misinformation and disinformation, in the post-truth era such as not jeopardizing effective solutions to eliminate the pandemic, e.g., taking the vaccine.

Moral grandstanding, narcissism, and self-reported responses to the COVID-19 crisis

The present study aimed to understand how status-oriented individual differences such as narcissistic antagonism, narcissistic extraversion, and moral grandstanding motivations may have longitudinally predicted both behavioral and social media responses during the early stages of the COVID-19 pandemic. Via YouGov, a nationally representative sample of U.S. adults was recruited in August of 2019 (N = 2,519; M_age  = 47.5, SD = 17.8; 51.4% women) and resampled in May of 2020, (N = 1,533). Results indicated that baseline levels of narcissistic antagonism were associated with lower levels of social distancing and lower compliance with public health recommended behaviors. Similarly, dominance oriented moral grandstanding motivations predicted greater conflict with others over COVID-19, greater engagement in status-oriented social media behaviors about COVID-19, and lower levels of social distancing.

Global intention of the general public to undergo COVID-19 vaccination: time trends and risk factors for vaccine refusal, a Systematic Review and Meta-analysis

Background:  Knowledge of facilitators and barriers regarding the uptake of COVID-19 vaccination at a global population level is critical for combating the pandemic, saving lives, and protecting the economy.  The aim of this work was to determine the proportion of people likely to accept or refuse to undergo COVID-19 vaccination.  This study also investigated (a) time trends regarding the intention to undergo COVID-19 vaccination and (b) socio-demographic risk factors influencing vaccine refusal. Methods: Databases (01 March 2020-01 March 2021) searched included PubMed, MEDLINE, and Scopus. The sample size was n ≥1000 and selected studies were those that determined vaccine ‘acceptance’, ‘refusal’ and ‘hesitancy’. A random-effects model was employed to obtain the overall odds ratio (OR) and 95% confidence interval (CI) for socio-demographic predictors for vaccine refusal. Results:  A total of 832 citations were screened and 35 studies from 21 countries (n=130,179) were analyzed.  The pooled proportion of individuals reporting an intention to vaccinate was 0.70 (95% CI: 0.65 to 0.74; I2 = 99.68%). The proportion of people intending to vaccinate decreased (regression coefficient = -0.13; p<0.001) during the study period and odds of refusal to vaccinate increased by 1.37-fold (95% CI: 1.33-1.41) during the second half. Risk factors identified for vaccine refusal included being female, rural residence, lower income, and lower level of formal education.  Conclusions: A moderate proportion of people showed an intention to receive vaccination, although this declined during the study period. A global and national multi-pronged strategic and targeted approach is urgently needed to enhance vaccination uptake amongst females, those with a relatively lower educational and socioeconomic status, and those in rural areas.

Joint analysis of the intention to vaccinate and to use contact tracing app during the COVID-19 pandemic

Pharmacological and non-pharmacological measures will overlap for a period after the onset of the pandemic, playing a strong role in virus containment. We explored which factors influence the likelihood to adopt two different preventive measures against the COVID-19 pandemic. An online snowball sampling (May-June 2020) collected a total of 448 questionnaires in Italy. A Bayesian bivariate Gaussian regression model jointly investigated the willingness to get vaccinated against COVID-19 and to download the national contact tracing app. A mixed-effects cumulative logistic model explored which factors affected the motivation to adopt one of the two preventive measures. Despite both COVID-19 vaccines and tracing apps being indispensable tools to contain the spread of SARS-CoV-2, our results suggest that adherence to the vaccine or to the national contact tracing app is not predicted by the same factors. Therefore, public communication on these measures needs to take in consideration not only the perceived risk associated with COVID-19, but also the trust people place in politics and science, their concerns and doubts about vaccinations, and their employment status. Further, the results suggest that the motivation to comply with these measurements was predominantly to protect others rather than self-protection.

Jab my arm, not my morality: Perceived moral reproach as a barrier to COVID-19 vaccine uptake

Background

Vaccinating the public against COVID-19 is critical for pandemic recovery, yet a large proportion of people remain unwilling to get vaccinated. Beyond known factors like perceived vaccine safety or COVID-19 risk, an overlooked sentiment contributing to vaccine hesitancy may rest in moral cognition. Specifically, we theorize that a factor fueling hesitancy is perceived moral reproach: the feeling, among unvaccinated people, that vaccinated people are judging them as immoral.

Approach

Through a highly powered, preregistered study of unvaccinated U.S. adults (N = 832), we found that greater perceived moral reproach independently predicted stronger refusal to get vaccinated against COVID-19, over and above other relevant variables. Of 18 predictors tested, perceived moral reproach was the fifth strongest—stronger than perceived risk of COVID-19, underlying health conditions status, and trust in scientists.

Conclusion

These findings suggest that considering the intersections of morality and upward social comparison may help to explain vaccine hesitancy.

Results of the COVID-19 mental health international for the general population (COMET-G) study

INTRODUCTION

There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study.

MATERIAL AND METHODS

During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

CONCLUSIONS

The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

The role of non-COVID-specific and COVID-specific factors in predicting a shift in willingness to vaccinate: A panel study

In communities that remain below the immunity threshold needed to blunt COVID-19’s spread, SARS-CoV-2 has a greater chance of mutating to evade vaccines. This study underscores the central role of trust and knowledge in increasing the likelihood of vaccinating. Trust in scientific institutions and spokespersons anchors time 1 vaccination intentions and knowledge affects them at both times 1 and 2. These background (non–COVID-specific) factors as well as flu vaccination history and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than did COVID-specific ones. The study underscores the need for ongoing community engagement and trust building, proactive communication about vaccination, motivating vaccination against seasonal flu, and deploying science-consistent, provaccination voices across media.

Although declines in intent to vaccinate had been identified in international surveys conducted between June and October 2020, including in the United States, some individuals in the United States who previously expressed reluctance said, in spring 2021, that they were willing to vaccinate. That change raised the following questions: What factors predicted an increased willingness to inoculate against COVID-19? And, to what extent was the change driven by COVID-specific factors, such as personal worry about the disease and COVID-specific misinformation, and to what extent by background (non–COVID-specific) factors, such as trust in medical authorities, accurate/inaccurate information about vaccination, vaccination history, and patterns of media reliance? This panel study of more than 8,000 individuals found that trust in health authorities anchored acceptance of vaccination and that knowledge about vaccination, flu vaccination history, and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than COVID-specific factors. COVID-specific conspiracy beliefs did play a role, although a lesser one. These findings underscore the need to reinforce trust in health experts, facilitate community engagement with them, and preemptively communicate the benefits and safety record of authorized vaccines. The findings suggest, as well, the need to identify and deploy messaging able to undercut health-related conspiracy beliefs when they begin circulating.

Vax attacks: How conspiracy theory belief undermines vaccine support

As the world continues to respond to the spread of a novel coronavirus (SARS-CoV-2, which causes the disease commonly known as COVID-19), it has become clear that one of the most effective strategies for curbing the pandemic is the COVID-19 vaccine. However, a major challenge that health organizations face when advocating for the uptake of the COVID-19 vaccine is the spread of related misinformation and conspiracy theories. This study examines factors that influence vaccine hesitancy using two online survey samples, one convenience and one nationally representative, collected in the early summer of 2020 during the height of the second peak of coronavirus cases in the United States. Given extant literature on vaccine hesitancy and conspiracy belief, we expect that three factors-conspiracy theory belief, political identity, and anti-intellectualism-have served to reduce COVID-19 vaccination likelihood. Accordingly, across our two independent samples we find that anti-intellectualism, conspiratorial predispositions, and COVID-19 conspiracy theory belief are the strongest and most consistent predictors of COVID-19 vaccine hesitancy. Notably, we also find that partisanship and political ideology are inconsistently significant predictors of COVID-19 vaccine hesitancy once conspiracy theory beliefs, anti-intellectualism, and control variables are accounted for in the models. When political tendencies are significant, they demonstrate a relatively small substantive association with COVID-19 vaccine hesitancy. We discuss implications for ongoing mass vaccination efforts, continued widespread vaccine hesitancy, and related political attitudes.

Predicting vaccine uptake during COVID-19 crisis: A motivational approach

The present research examined which motivational factors contribute to individuals’ intention to take a vaccine that protects against SARS-CoV-2-virus and their self-reported vaccine uptake several months later. The role of different types of motivation was investigated (i.e., autonomous and controlled regulation) as well as vaccine distrust and effort to obtain a vaccine. Across two large-scale cross-sectional (N = 8887) and longitudinal (N = 6996) studies and controlling for various covariates, autonomous motivation and distrust-based amotivation contributed positively and negatively, respectively, to a) concurrent vaccination intentions, b) self-reported vaccination and c) subsequent subscription to a waitlist to obtain a vaccine. Participants’ infection-related risk perception predicted more positive vaccination outcomes through fostering greater autonomous motivation for vaccination and lower distrust, whereas pandemic-related health concerns failed to yield such adaptive effects. The results emphasize the importance of fostering autonomous motivation for vaccination and handling distrust.

The Mediating Roles of Medical Mistrust, Knowledge, Confidence and Complacency of Vaccines in the Pathways from Conspiracy Beliefs to Vaccine Hesitancy

Background: Vaccine hesitancy, associated with medical mistrust, confidence, complacency and knowledge of vaccines, presents an obstacle to the campaign against the coronavirus disease 2019 (COVID-19). The relationship between vaccine hesitancy and conspiracy beliefs may be a key determinant of the success of vaccination campaigns. This study provides a conceptual framework to explain the impact of pathways from conspiracy beliefs to COVID-19 vaccine hesitancy with regard to medical mistrust, confidence, complacency and knowledge of vaccines. Methods: A non-probability study was conducted with 1015 respondents between 17 April and 28 May 2021. Conspiracy beliefs were measured using the coronavirus conspiracy scale of Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS), and vaccine conspiracy beliefs scale. Medical mistrust was measured using the Oxford trust in doctors and developers questionnaire, and attitudes to doctors and medicine scale. Vaccine confidence and complacency were measured using the Oxford COVID-19 vaccine confidence and complacency scale. Knowledge of vaccines was measured using the vaccination knowledge scale. Vaccine hesitancy was measured using the Oxford COVID-19 vaccine hesitancy scale. Confirmatory factor analysis (CFA) was used to evaluate the measurement models for conspiracy beliefs, medical mistrust, confidence, complacency, and knowledge of vaccines and vaccine hesitancy. The structural equation modeling (SEM) approach was used to analyze the direct and indirect pathways from conspiracy beliefs to vaccine hesitancy. Results: Of the 894 (88.1%) respondents who were willing to take the COVID-19 vaccine without any hesitancy, the model fit with the CFA models for conspiracy beliefs, medical mistrust, confidence, complacency and knowledge of vaccines, and vaccine hesitancy was deemed acceptable. Conspiracy beliefs had significant direct (β = 0.294), indirect (β = 0.423) and total (β = 0.717) effects on vaccine hesitancy; 41.0% of the total effect was direct, and 59.0% was indirect. Conspiracy beliefs significantly predicted vaccine hesitancy by medical mistrust (β = 0.210), confidence and complacency (β = 0.095), knowledge (β = 0.079) of vaccines, explaining 29.3, 11.0, and 13.2% of the total effects, respectively. Conspiracy beliefs significantly predicted vaccine hesitancy through the sequential mediation of knowledge of vaccines and medical mistrust (β = 0.016), explaining 2.2% of the total effects. Conspiracy beliefs significantly predicted vaccine hesitancy through the sequential mediation of confidence and complacency, and knowledge of vaccines (β = 0.023), explaining 3.2% of the total effects. The SEM approach indicated an acceptable model fit (χ²/df = 2.464, RMSEA = 0.038, SRMR = 0.050, CFI = 0.930, IFI = 0.930). Conclusions: The sample in this study showed lower vaccine hesitancy, and this study identified pathways from conspiracy beliefs to COVID-19 vaccine hesitancy in China. Conspiracy beliefs had direct and indirect effects on vaccine hesitancy, and the indirect association was determined through medical mistrust, confidence, complacency, and knowledge of vaccines. In addition, both direct and indirect pathways from conspiracy beliefs to vaccine hesitancy were identified as intervention targets to reduce COVID–19 vaccine hesitancy.

Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis

Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in vaccination intentions will be influenced by beliefs around vaccines to influence health. Often perceptions of what others are doing and the information available guide individuals' behaviors for vaccination. This is more so in the digital age with the influence of the internet and media. This study aims to determine the factors that impact willingness to vaccinate for COVID-19. We examined factors associated with acceptance of vaccine based on (1) constructs of the Health Belief Model (HBM), (2) sources of information, (3) social media usage, (4) knowledge of COVID-19 treatment, and (5) perception of government's efforts for mitigation. Randomly sampled online survey data was collected by a global firm between December 2020 and January 2021 from 372 citizens (with a response rate of 96.6%) from multiple regions, including North America, the Middle East, Europe, and Asia. Ordered probit regression suggests that the health belief model constructs hold. Perceived severity of COVID-19 (P < 0.001) and action cues of others taking the vaccine positively influences a subject's vaccine intent (P < 0.001), perceived benefits and perceived efficacy of the vaccine positively influences a subject's vaccine intent (P < 0.001). Perceived barriers negatively influence vaccine intent (P < 0.001). Interestingly as for media usage, mainstream media (e.g., TV, newspaper) (P = 0.006) and social media (P = 0.013) both negatively influence a subject's vaccine intent. Social media platforms that are more entertainment and social-based, such as Whatsapp, Instagram, and YouTube, have a negative and significant influence on vaccine intent (P = 0.061), compared to other more information-based social media platforms (e.g., Twitter, LinkedIn). Knowledge of COVID-19 treatment positively influences vaccine intent (P = 0.023). Lastly, governmental efforts' perceived reliability in mitigation strategy (P = 0.028) and response efforts (P = 0.004) negatively influence vaccine intent. The study highlights the "wait-and-see" action cue from others and leaders in the community. It also informs the importance of shaping media information for vaccination through informative media and social media outlets to counteract any misinformation.

National survey of attitudes towards and intentions to vaccinate against COVID-19: implications for communications

OBJECTIVES

To examine public views on COVID-19 vaccination and consider the implications for communications and targeted support.

DESIGN

Cross-sectional study.

SETTING

Online and telephone nationally representative survey in Great Britain, January to February 2021.

PARTICIPANTS

4978 adults. Survey response rate was 84%, among the 5931 panellists invited.

MAIN OUTCOME MEASURES

Sociodemographic characteristics (age, gender, ethnicity, education, financial status), COVID-19 status, vaccine acceptance, trust in COVID-19 vaccination information sources, perceptions of vaccination priority groups and perceptions of importance of second dose.

RESULTS

COVID-19 vaccine acceptance (83%) was associated with increasing age, higher level of education and having been invited for vaccination. Acceptance decreased with unconfirmed past COVID-19, greater financial hardship and non-white British ethnicity; black/black British participants had lowest acceptance. Overall, healthcare and scientific sources of information were most trusted. Compared with white British participants, other ethnicities had lower trust in healthcare and scientific sources. Those with lower educational attainment or financial hardship had lower trust in healthcare and scientific sources. Those with no qualifications had higher trust in media and family/friends. While trust was low overall in community or faith leaders, it was higher among those with Asian/Asian British and black/black British ethnicity compared with white British participants. Views of vaccine prioritisation were mostly consistent with UK official policy but there was support for prioritising additional groups. There was high support for having the second vaccine dose.

CONCLUSIONS

Targeted engagement is needed to address COVID-19 vaccine hesitancy in non-white British ethnic groups, in younger adults, and among those with lower education, greater financial hardship and unconfirmed past infection. Healthcare professionals and scientific advisors should play a central role in communications and tailored messaging is needed for hesitant groups. Careful communication around vaccination prioritisation continues to be required.

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality.

A Rapid Systematic Review of Factors Influencing COVID-19 Vaccination Uptake in Minority Ethnic Groups in the UK

COVID-19 has disproportionately affected minority ethnic groups in the United Kingdom. To maximise the effectiveness of the vaccination programme, it is important to understand and address disparities in vaccine uptake. The aim of this review was to identify factors influencing COVID-19 vaccination uptake between minority ethnic groups in the UK. A search was undertaken in peer-reviewed databases, polling websites and grey literature from January 2020-May 2021. Studies were included if they reported data on vaccine uptake or the reasons for or against accepting the COVID-19 vaccination for minority ethnic groups in the UK. Twenty-one papers met the inclusion criteria, all of which were rated as either good or moderate quality. Ethnic minority status was associated with higher vaccine hesitancy and lower vaccine uptake compared with White British groups. Barriers included pre-existing mistrust of formal services, lack of information about the vaccine's safety, misinformation, inaccessible communications, and logistical issues. Facilitators included inclusive communications which address vaccine concerns via trusted communicators and increased visibility of minority ethnic groups in the media. Community engagement to address the concerns and informational needs of minority ethnic groups using trusted and collaborative community and healthcare networks is likely to increase vaccine equity and uptake.

Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study

Background

The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms.

Objective

We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance.

Methods

Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy.

Results

The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic.

Conclusions

Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination.

Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy

As COVID-19 vaccines are rolled out across the world, there are growing concerns about the roles that trust, belief in conspiracy theories, and spread of misinformation through social media play in impacting vaccine hesitancy. We use a nationally representative survey of 1476 adults in the UK between 12 and 18 December 2020, along with 5 focus groups conducted during the same period. Trust is a core predictor, with distrust in vaccines in general and mistrust in government raising vaccine hesitancy. Trust in health institutions and experts and perceived personal threat are vital, with focus groups revealing that COVID-19 vaccine hesitancy is driven by a misunderstanding of herd immunity as providing protection, fear of rapid vaccine development and side effects, and beliefs that the virus is man-made and used for population control. In particular, those who obtain information from relatively unregulated social media sources-such as YouTube-that have recommendations tailored by watch history, and who hold general conspiratorial beliefs, are less willing to be vaccinated. Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials, and social media companies. More attention needs to be devoted to helping people understand their own risks, unpacking complex concepts, and filling knowledge voids.

Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy

As COVID-19 vaccines are rolled out across the world, there are growing concerns about the roles that trust, belief in conspiracy theories, and spread of misinformation through social media play in impacting vaccine hesitancy. We use a nationally representative survey of 1476 adults in the UK between 12 and 18 December 2020, along with 5 focus groups conducted during the same period. Trust is a core predictor, with distrust in vaccines in general and mistrust in government raising vaccine hesitancy. Trust in health institutions and experts and perceived personal threat are vital, with focus groups revealing that COVID-19 vaccine hesitancy is driven by a misunderstanding of herd immunity as providing protection, fear of rapid vaccine development and side effects, and beliefs that the virus is man-made and used for population control. In particular, those who obtain information from relatively unregulated social media sources-such as YouTube-that have recommendations tailored by watch history, and who hold general conspiratorial beliefs, are less willing to be vaccinated. Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials, and social media companies. More attention needs to be devoted to helping people understand their own risks, unpacking complex concepts, and filling knowledge voids.