Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: A multicenter survey

COVID-19 vaccination hesitancy and associated factors among solid organ transplant recipients in China

The mortality rate from COVID-19 appears to be higher in solid organ transplant (SOT) recipients when compared with other populations. Vaccination is a key strategy to prevent the COVID-19 pandemic. However, it is unclear how readily SOT recipients will get vaccinated against COVID-19. We conducted an internet-based survey to investigate the vaccination willingness among Chinese SOT recipients and further explore possible influencing factors. Eight hundred and thirteen respondents participated in the survey. Overall, 46 (5.7%) recipients were vaccinated against COVID-19, while 767 (94.3%) were not. Among those not vaccinated, 175 (22.8%) intended to be vaccinated, while 592 (77.2%) were categorized as vaccine-hesitant. The most common reason for vaccination hesitancy is fear of preexisting comorbidities, followed by fear of side effects and doctors' negative advice. Factors associated with vaccination willingness were as follows: with liver transplantation, the main source of information on COVID-19 vaccines was from medical doctors, scientists, and scientific journals, with at least college-level education, positive intention toward influenza vaccination during the current season, perceived importance of vaccination for SOT recipients, and having been vaccinated against influenza during the last season. Our survey indicated the necessity for SOT recipients to receive more comprehensive and accessible health education about vaccination and emphasized the critical role of transplantation physicians in promoting vaccine acceptance among SOT recipients. We hope that our survey results will help governments to better target communication in the ongoing COVID-19 vaccination campaign.

Attitude Towards COVID-19 Vaccination Among Healthcare Workers: A Systematic Review

INTRODUCTION

Availability and accessibility of a safe COVID-19 vaccine do not necessarily guarantee an effective means to mitigate the pandemic. However, the fragile hero's or health care worker's attitude toward the vaccine is of paramount importance to promote its acceptance. So, the current review aims to provide the latest assessment of healthcare workers' attitudes toward the COVID-19 vaccination and its contributing factor worldwide.

METHODS

Peer-reviewed surveys in English indexed via an electronic database in Google Scholar, Science Direct and PubMed were systematically searched. The review was carried out per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD42021265534).

RESULTS

Originally 8039 articles were searched from three databases PubMed, Science direct, and Google scholar. Finally, 24 studies met the inclusion criteria and made the root for the estimates of the attitude of COVID -19 vaccinations. In about two-thirds of the studies, respondents showed a positive attitude (≥50%) toward COVID-19 vaccination. However, in about one-quarter of the studies, a negative attitude (<50%) against vaccination was reported. Factors related to the attitude of healthcare workers toward COVID-19 vaccination include age, sex, profession, concerns about the safety of vaccines and fear of COVID-19, trust in the accuracy of the measures taken by the government, flu vaccination during the previous season, comorbid chronic illness, history of recommendation, and depression symptoms in the past week.

CONCLUSION

Although most studies report that healthcare workers have a positive attitude toward COVID-19 vaccination, quite a few surveys mention negative attitudes towards the use of vaccines, which may reflect missed opportunities or challenges for the international efforts aimed at mitigating the pandemic. Still, we need to continue to make more efforts to change the attitudes of the uncertain healthcare workers to increase the uptake of the vaccine and deal with the multi-faceted impact of infection.

Predictors of Willingness to Receive COVID-19 Vaccine: Cross-Sectional Study of Palestinian Dental Students

The overarching aim of this study was to assess the predictors related to the willingness of Palestinian dental students to receive the COVID-19 vaccine when it becomes available. A cross-sectional study was conducted among a universal sample of dental students in the Palestinian territories. Willingness to get the COVID-19 vaccine was related to the following factors: Demographic characteristics, COVID-19-related experiences, beliefs and knowledge about the vaccine, attitudes toward vaccinations in general, and other factors outlined by the WHO SAGE Vaccination Hesitancy Questionnaire. Four hundred and seventeen students completed the questionnaire (response rate = 41.7%). In general, 57.8% (n = 241) were willing to take the COVID-19 vaccine when it became available to them, 27% (n = 114) were hesitant, and 14.9% (n = 62) were not willing to get vaccinated. The final regression model explained 46% of the variation in the willingness to receive the COVID-19 vaccine as follows: Attitudes towards new vaccines (β = 6.23, p < 0.001), believing in a favorable risk-benefit ratio (β = 5.64, p < 0.001), trust in the pharmaceutical industry (β = 5.92, p = 0.001), believing that natural immunity is better than being vaccinated (β = -4.24, p < 0.001), and having enough information about the vaccine (β = 4.12, p < 0.001). Adequate information about vaccines, their risk-benefit ratios, and natural and acquired immunity are important to build trust and favorable attitudes towards vaccines among future dentists.

Evaluation of COVID-19 Vaccine Attitudes among Arab American Healthcare Professionals Living in the United States

BACKGROUND

Vaccine hesitancy is the next great barrier for public health. Arab Americans are a rapidly growing demographic in the United States with limited information on the prevalence of vaccine hesitancy. We therefore sought to study the attitudes towards the coronavirus disease 2019 (COVID-19) vaccine amongst Arab American health professionals living in the United States.

METHODS

This was a cross sectional study utilizing an anonymous online survey. The survey was distributed via e-mail to National Arab American Medical Association members and Arab-American Center for Economic and Social Services healthcare employees. Respondents were considered vaccine hesitant if they selected responses other than a willingness to receive the COVID-19 vaccine.

RESULTS

A total of 4000 surveys were sent via e-mail from 28 December 2020 to 31 January 2021, and 513 responses were received. The highest group of respondents were between the ages of 18-29 years and physicians constituted 48% of the respondents. On multivariable analysis, we found that respondents who had declined an influenza vaccine in the preceding 5 years (p < 0.001) and allied health professionals (medical assistants, hospital administrators, case managers, researchers, scribes, pharmacists, dieticians and social workers) were more likely to be vaccine hesitant (p = 0.025). In addition, respondents earning over $150,000 US dollars annually were less likely to be vaccine hesitant and this finding was significant on multivariable analysis (p = 0.011).

CONCLUSIONS

Vaccine hesitancy among health care providers could have substantial impact on vaccine attitudes of the general population, and such data may help inform vaccine advocacy efforts.

Acceptance of COVID-19 Vaccine and Determinant Factors Among Patients with Chronic Disease Visiting Dessie Comprehensive Specialized Hospital, Northeastern Ethiopia

BACKGROUND

Despite the implementation of different COVID-19 prevention measures, the incidence of the disease continues to rise. Hence, vaccines have been taken as the best option for controlling the transmission of the disease. Although the approved COVID-19 vaccines have proven to be safe and effective, multiple beliefs and misconceptions still exist influencing its acceptance.

OBJECTIVE

To assess the acceptance of the COVID-19 vaccine and determinant factors among chronic patients visiting Dessie Comprehensive Specialized Hospital, Northeastern Ethiopia.

METHODS

Institution-based cross-sectional study design was used among patients with chronic diseases visiting Dessie Comprehensive Specialized Hospital from May 1 to 20, 2021 using a consecutive sampling technique. Binary logistic regression analysis using crude odd ratio (COR) and adjusted odd ratio (AOR) was performed to assess the association between independent and dependent variables. Variables having p values of less than 0.05 at the 95% confidence interval (CI) were considered as factors of COVID-19 vaccine acceptance.

RESULTS

A total of 416 respondents participated in the survey, with a response rate of 98.6%. About 59.4% of the respondents were willing to accept the COVID-19 vaccine. Participants who had health insurance (AOR=1.812; 95% CI: 1.703-3.059), knew anyone diagnosed with COVID-19 (AOR=2.482; 95% CI: 1.427-4.317), having good knowledge of the COVID-19 vaccine (AOR=6.890; 95% CI: 3.900-120.17), and having a positive attitude towards COVID-19 vaccine (AOR=7.725; 95% CI: 4.024-14.830) were factors affecting the acceptance of COVID-19 vaccine.

CONCLUSION

The acceptance of the COVID-19 vaccine was low. Use of health insurance, knowing anyone who had been diagnosed with COVID-19, knowledge, and attitude towards the COVID-19 vaccine were factors of COVID-19 vaccine acceptance. Healthcare professionals should conduct continuous awareness creation campaigns on the importance of the COVID-19 vaccine, safety, and its efficacy. Further studies like longitudinal and qualitative studies should be conducted to identify additional barriers to vaccine acceptance particularly in high-risk groups.

Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign

Vaccinations used to prevent coronavirus disease (COVID-19)-the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060-11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Coronavirus disease 2019 vaccine acceptance and perceived barriers among university students in northeast Ethiopia: A cross-sectional study

Background

Universities are places where students live and study in close contact to each other. Nowadays, the foundations of this particular group have been affected significantly by the rapid spread of the coronavirus disease 2019. The severity of the COVID-19 pandemic has demanded the emergency use of COVID-19 vaccines. However, there is still limited evidence in COVID-19 vaccine acceptability and perceived barriers among some subgroups, including university students. This study aimed to assess vaccine acceptance, associated factors, and perceived barriers among university students, Ethiopia.

Methods

A cross-sectional study was conducted in January 2021 at Debre Berhan University among 423 students. The participants were selected using simple random sampling technique. A semi-structured, pretested, and self-administered questionnaire was used to collect the data. Multivariable logistic-regression model was fitted to identify factors associated with vaccine acceptance. An adjusted odds ratio with 95% confidence interval and its p-value of ≤0.05 was used to declare significant association.

Results

The proportion of the COVID-19 vaccine acceptance was 69.3% (95% CI: 65, 74). Being knowledgeable (AOR: 2.43, CI: 1.57, 3.77), being a health science student (AOR: 2.25, CI: 1.43, 3.54), and being in a family practicing COVID-19 prevention (AOR: 1.73, CI: 1.06, 2.81) were found to be factors associated with COVID-19 vaccine acceptance.

Conclusion

Though, this study found a 69.3% acceptance of COVID-19 vaccine, there were noticeable perceived barriers and related factors in vaccine acceptance hesitancy. Thus, health education and communication regarding the vaccine are very crucial to alleviate the identified barriers.

Motivation to COVID-19 Vaccination and Reasons for Hesitancy in Employees of a Czech Tertiary Care Hospital: A Cross-Sectional Survey

High vaccination coverage among healthcare workers (HCWs) is crucial for managing the COVID-19 pandemic. The aim was to determine the demand for vaccination among all employees (n = 4553) of a tertiary care hospital after several weeks of the vaccine's availability, and to analyze motives for acceptance and reasons for hesitancy through an anonymous online questionnaire. Upon the completion of data collection, the hospital's vaccination coverage was at 69.8%. A total of 3550 completed questionnaires were obtained (2657 from vaccinated, 893 from unvaccinated employees). Significant predictors of vaccine acceptance were: age (odds ratio (OR) 1.01, 95% confidence interval (CI) 1.01-1.02), sex (OR (females) 0.58, 95% CI 0.45-0.75), job type (OR (non-physician HCWs) 0.54, 95% CI 0.41-0.72; OR (non-HCWs) 0.51, 95% CI 0.37-0.71), fear of COVID-19 (OR 1.4, 95% CI 1.34-1.46), history of COVID-19 (OR 0.41, 95% CI 0.34-0.49) and of influenza vaccination (OR 2.74, 95% CI 2.12-3.57). The most frequent motive for acceptance was the effort to protect family members (84%), while concerns about vaccine safety and side effects (49.4%), followed by distrust in the vaccine's efficacy (41.1%) were the top reasons for hesitancy. To increase vaccination coverage among HCWs, it is necessary to raise awareness of vaccine safety and efficacy.

COVID-19 Vaccine Hesitancy and Uptake among Nursing Staff during an Active Vaccine Rollout

Even with the availability of COVID-19 vaccines, factors associated with vaccine hesitancy and uptake among nurses are unknown. This study evaluated COVID-19 vaccine hesitancy and uptake of nursing staff during one of the first COVID-19 vaccine rollouts in the United States. A cross-sectional survey was conducted during February 2021 among nursing staff working in a large medical center in central United States. There were 276 respondents; 81.9% of participants were willing to receive the vaccine during the initial rollout, 11.2% were hesitant, and only 5.1% were unwilling. The hesitant group was likely to report having inadequate information to make an informed decision about whether to receive the vaccine (45.2%) and about vaccine expectations (32.3%). The majority (83.3%) received at least one dose of the vaccine. Having greater than 10 years’ work experience (OR 3.0, 95% CI 1.16–7.9) and confidence in vaccine safety (OR 7.78, 95% CI 4.49–13.5) were significantly associated with vaccine uptake. While our study indicates higher vaccine uptake among nursing staff during an active vaccine rollout, there remains sustained hesitancy and unwillingness to uptake. For those hesitant to receive the COVID-19 vaccine, public health efforts to provide more data on side effects and efficacy may help increase vaccine uptake.

COVID-19 Vaccination Acceptance and Hesitancy among Healthcare Workers in Germany

Vaccination hesitancy is a threat to herd immunity. Healthcare workers (HCWs) play a key role in promoting Coronavirus disease 2019 (COVID-19) vaccination in the general population. We therefore aimed to provide data on COVID-19 vaccination acceptance/hesitancy among German HCWs. For this exploratory, cross-sectional study, an online survey was conducted in February 2021. The survey included 54 items on demographics; previous vaccination behavior; trust in vaccines, physicians, the pharmaceutical industry and health politics; fear of adverse effects; assumptions regarding the consequences of COVID-19; knowledge about vaccines; and information seeking behavior. Odds ratios with 95% confidence intervals were calculated and chi-square tests were performed. Four thousand five hundred surveys were analyzed. The overall vaccination acceptance was 91.7%. The age group ≤20 years showed the lowest vaccination acceptance. Factors associated with vaccination hesitancy were lack of trust in authorities and pharmaceutical companies. Attitudes among acquaintances were associated with vaccination hesitancy too. Participants with vaccination hesitancy more often obtained information about COVID-19 vaccines via messenger services or online video platforms and underperformed in the knowledge test. We found high acceptance amongst German HCWs. Several factors associated with vaccination hesitancy were identified which could be targeted in HCW vaccination campaigns.

Psychological Determinants of COVID-19 Vaccine Acceptance among Healthcare Workers in Kuwait: A Cross-Sectional Study Using the 5C and Vaccine Conspiracy Beliefs Scales

Acceptance of coronavirus disease 2019 (COVID-19) vaccination appears as a decisive factor necessary to control the ongoing pandemic. Healthcare workers (HCWs) are among the highest risk groups for infection. The current study aimed to evaluate COVID-19 vaccine acceptance among HCWs in Kuwait, with identification of the psychological determinants of COVID-19 vaccine hesitancy. The study was conducted using an online anonymous survey distributed between 18 March 2021 and 29 March 2021. The sampling strategy was convenience-based depending on chain-referral sampling. Psychological determinants of COVID-19 vaccine acceptance were assessed using the 5C subscales and the Vaccine Conspiracy Beliefs Scale (VCBS). The total number of study participants was 1019, with the largest group being physicians (28.7%), pharmacists (20.2%), dentists (16.7%), and nurses (12.5%). The overall rate for COVID-19 vaccine acceptance was 83.3%, with 9.0% who were not willing to accept vaccination and 7.7% who were unsure. The highest rate for COVID-19 vaccine acceptance was seen among dentists (91.2%) and physicians (90.4%), while the lowest rate was seen among nurses (70.1%; p < 0.001). A higher level of COVID-19 vaccine hesitancy was found among females, participants with a lower educational level, and HCWs in the private sector. A preference for mRNA vaccine technology and Pfizer-BioNTech COVID-19 vaccine was found among the majority of participants (62.6% and 69.7%, respectively). COVID-19 vaccine hesitancy was significantly linked to the embrace of vaccine conspiracy beliefs. The highest 5C psychological predictors of COVID-19 vaccine acceptance were high levels of collective responsibility and confidence, and lower levels of constraints and calculation. The VCBS and 5C subscales (except the calculation subscale) showed acceptable levels of predicting COVID-19 vaccine acceptance based on receiver operating characteristic analyses. The participants who depended on social media platforms, TV programs, and news releases as their main sources of knowledge about COVID-19 vaccines showed higher rates of COVID-19 vaccine hesitancy. An overall satisfactory level of COVID-19 vaccine acceptance was seen among HCWs in Kuwait, which was among the highest rates reported globally. However; higher levels of vaccine hesitancy were observed among certain groups (females, nurses and laboratory workers, HCWs in the private sector), which should be targeted with more focused awareness programs. HCWs in Kuwait can play a central role in educating their patients and the general public about the benefits of COVID-19 vaccination to halt the spread of SARS-CoV-2, considering the high rates of vaccine hesitancy observed among the general public in Kuwait and the Middle East.

Barriers and facilitators to influenza and pneumococcal vaccine hesitancy in rheumatoid arthritis: a qualitative study

OBJECTIVE

Immunization is an essential component of rheumatoid arthritis (RA) care. Nevertheless, vaccine coverage in RA is suboptimal. Contextual, individual, and vaccine-related factors influence vaccine acceptance. However, barriers and facilitators of vaccination in RA are not well defined. The aim of this study was to assess perspectives of RA patients and health care professionals (HCPs) involved in RA care of barriers and facilitators regarding influenza and pneumococcal vaccines.

METHODS

Eight focus groups (4 with RA patients and 4 with HCPs), and eight semi-structured open-ended individual interviews with vaccine hesitant RA patients were conducted. Data were audio-recorded, transcribed verbatim, and imported to the MAXQDA software. Analysis using the framework of vaccine hesitancy proposed by the Strategic Advisory Group of Experts (SAGE) on Immunization was conducted.

RESULTS

RA patients and HCPs reported common and specific barriers and facilitators to influenza vaccination that included contextual, individual and/or group, and vaccine and/or vaccination specific factors. A key contextual influence on vaccination was patients' perception of the media, pharmaceutical industry, authorities, scientists, and the medical community at large. Among the individual-related influences, experiences with vaccination, knowledge/awareness, and beliefs about health and disease prevention were considered to impact vaccine-acceptance. Vaccine-related factors including concerns of vaccine side effects such as RA flares, safety of new formulations, mechanism of action, access to vaccines and costs associated with vaccination were identified as actionable barriers.

CONCLUSION

Acknowledging RA patients' perceived barriers to influenza and pneumococcal vaccination and implementing specific strategies to address them might increase vaccination coverage in this population.

Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada

COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies.

Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.