Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial

A mixed-methods study to assess COVID-19 vaccination acceptability among university students in the United Arab Emirates

To effectively achieve herd immunity against COVID-19, a substantial proportion of a population would need to be vaccinated. However, vaccine hesitancy and refusal are significant issues globally. This mixed-methods study aimed to investigate university students' attitudes in the United Arab Emirates (UAE) toward the COVID-19 vaccination, determine the factors associated with vaccine hesitancy, and understand the underlying reasons. We conducted an online survey between 16th-24th February 2021 in 669 students from the University of Sharjah (UAE) and semi-structured qualitative interviews with a subsample of 11 participants. Data on COVID-19 vaccine intention and uptake, risk perception, beliefs and attitudes toward the disease and the vaccine were collected. Multinomial logistic regression was applied and thematic content analysis was conducted with qualitative data. Overall, 31.8% of students demonstrated vaccine hesitancy; 24.4% of students reported a high intention to get the vaccine, and 43.8% were already vaccinated. Vaccine hesitancy was associated with less positive beliefs and attitudes toward the COVID-19 vaccine (AdjOR = 0.557;95%CI 0.468-0.662), high perceived adverse effects (AdjOR = 1.736;95%CI 1.501-2.007), and not perceiving easy access to a vaccination center (AdjOR = 0.820;95%CI 0.739-0.909). The main reasons underlying vaccine hesitancy were related to uncertainty about the effectiveness of the vaccine, knowledge about negative experiences from vaccination among family and/or community, overvaluing the risks of the vaccine in relation to the potential benefits, and not perceiving immunization as a social norm. To increase COVID-19 vaccination uptake, interventions to reduce hesitancy could focus on reducing fears about adverse effects and highlighting individual and societal benefits of the vaccination.

Social nudges for vaccination: How communicating herd behaviour influences vaccination intentions

Objectives

This Registered Report attempted to conceptually replicate the finding that communicating herd immunity increases vaccination intentions (Betsch, et al., 2017, Nat. Hum. Behav., 0056). An additional objective was to explore the roles of descriptive social norms (vaccination behaviour of others) and the herd‐immunity threshold (coverage needed to stop disease transmission).

Design

An online experiment with a 2 (herd‐immunity explanation: present vs. absent) × 3 (descriptive norm: high vs. low vs. absent) × 2 (herd‐immunity threshold: present vs. absent) between‐subjects fractional design.

Methods

Sample consisted of 543 people (aged 18–64) residing in the United Kingdom. Participants first received an explanation of herd immunity emphasising social benefits (protecting others) in both textual and animated‐infographic form. Next, they were faced with fictitious information about the disease, the vaccine, their country’s vaccination coverage (80% or 20%), and the herd‐immunity threshold (90%). Vaccination intention was self‐rated.

Results

Compared to the control, communicating social benefits of herd immunity was effective in increasing vaccination intentions (F(1,541) = 6.97, p = .009, Partial Eta‐Squared = 0.013). Communicating the descriptive norm or the herd‐immunity threshold alongside the herd‐immunity explanation demonstrated no observable effect.

Conclusion

Communicating social benefits of herd immunity increased self‐reported vaccination intentions against a fictitious disease, replicating previous findings. Although this result is positive, the practical relevance may be limited. Further research into the effect of social nudges to motivate vaccination is required, particularly with respect to the recent pandemic context and varying levels of vaccine hesitancy.

Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy

Purposes: To explore the associated factors of COVID-19 vaccine hesitancy and examine psychometric properties of the coronavirus-related health literacy questionnaire (HLS-COVID-Q22) and Oxford COVID-19 Vaccine Hesitancy questionnaire. Methods: An online survey was conducted from 23 June to 16 July 2021 on 387 school principals across Taiwan. Data collection included socio-demographic characteristics, information related to work, physical and mental health, COVID-19 related perceptions, sense of coherence, coronavirus-related health literacy, and vaccine hesitancy. Principal component analysis, correlation analysis, linear regression models were used for validating HLS-COVID-Q22, Oxford COVID-19 Vaccine Hesitancy, and examining the associations. Results: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were found with satisfactory construct validity (items loaded on one component with factor loading values range 0.57 to 0.81, and 0.51 to 0.78), satisfactory convergent validity (item-scale correlations range 0.60 to 0.79, and 0.65 to 0.74), high internal consistency (Cronbach’s alpha = 0.96 and 0.90), and without floor or ceiling effects (percentages of possibly lowest score and highest score <15%), respectively. Low scores of vaccine hesitancy were found in male principals (regression coefficient, B, −0.69; 95% confidence interval, 95%CI, −1.29, −0.10; p = 0.023), principals with better well-being (B, −0.25; 95%CI, −0.47, −0.03; p = 0.029), and higher HLS-COVID-Q22 (B, −1.22; 95%CI, −1.89, −0.54; p < 0.001). Conclusions: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were valid and reliable tools. Male principals and those with better well-being, and higher health literacy had a lower level of vaccine hesitancy. Improving principals’ health literacy and well-being is suggested to be a strategic approach to increase vaccine acceptance for themselves, their staff, and students.

"To Protect Myself, My Friends, Family, Workmates and Patients …and to Play My Part": COVID-19 Vaccination Perceptions among Health and Aged Care Workers in New South Wales, Australia

The 2019 coronavirus disease (COVID-19) pandemic has globally caused widespread disruption, morbidity and mortality. The uptake of COVID-19 vaccination is critical for minimising further impacts of the pandemic. Health and aged care workers (HACWs) play a central role in public confidence in vaccines and are one of the priority groups for COVID-19 vaccination in Australia. Qualitative phone interviews with 19 HACWs aged 21–50 years old from New South Wales, Australia, were conducted, and the data were analysed thematically in order to understand the factors influencing HACWs’ acceptance of COVID-19 vaccination. We found that HACWs reported a continuum of COVID-19 vaccination intentions with 12 enthusiastically accepting and 7 hesitant. Using the Behavioral and Social Drivers of COVID-19 Vaccination (BeSD) Framework, we found that participants’ acceptance of vaccination was primarily driven by their perceptions of COVID-19 vaccination (such as safety, risk and benefits) and by the information sources, people and norms they trusted. Informed by study findings, we propose several communication strategies which may be helpful in addressing HACWs vaccination acceptance. We note however that as the pandemic continues, further studies with HACWs from diverse backgrounds are needed in order to provide accurate data on diverse motivational and practical drivers of evolving perceptions and attitudes towards vaccination.

Factors Affecting Hesitancy to mRNA and Viral Vector COVID-19 Vaccines among College Students in Italy

Vaccine hesitancy (VH) may be significant in jeopardizing efforts to mass containment of COVID-19. A cross-sectional survey was carried out on a sample of 2667 Italian college students, before the COVID-19 vaccines became available for this age group (from 7 May to 31 May 2021). An online survey was created to obtain information about socio-demographic, health-related, and psychological factors linked to mRNA and viral vector COVID-19 vaccines. Statistically significant higher VH (30.4%) and vaccine resistance (12.2%) rates were found for viral vector than mRNA COVID-19 vaccines (7.2% and 1.0%, respectively; p < 0.001). Factors related to viral vector VH were partially different from those related to mRNA VH. Students with greater endorsement on conspiracy statements and negative attitudes toward the vaccine had higher odds of being vaccine-hesitant or -resistant. Students who had received a previous COVID-19 test and who scored higher on the agreeableness personality dimension had lower odds to be vaccine-hesitant or -resistant. The willingness to choose the vaccine was related to the viral vector but not to the mRNA VH. Taking into consideration the factors involved in vaccine hesitancy/resistance in college students could represent a key public health strategy to increase vaccine coverage and reduce viral spreading.

Prosocial vaccination

Most vaccines not only directly protect vaccinated individuals but also provide a social benefit through community protection. Therefore, vaccination can be considered a prosocial act to protect others. We review the recent empirical evidence on (i) how prosocial concerns relate to vaccination intentions and (ii) promoting prosocial vaccination through explaining community protection or inducing concern for vulnerable others. The available evidence suggests that promoting the prosocial aspect of vaccinations could be a vaccination communication strategy to improve vaccine uptake. We point to several areas in which future research can test the boundary conditions of this approach and increase its effectiveness.

The Relationship between US Adults' Misconceptions about COVID-19 Vaccines and Vaccination Preferences

While mass vaccination has blunted the pandemic in the United States, pockets of vaccine hesitancy remain. Through a nationally representative survey of 1027 adult Americans conducted in February 2021, this study examined individual misconceptions about COVID-19 vaccine safety; the demographic factors associated with these misconceptions; and the relationship between misconceptions and willingness to vaccinate. Misconceptions about vaccine safety were widespread. A sizeable minority (40%) believed that vaccine side effects are commonly severe or somewhat severe; 85% significantly underestimated the size and scale of the clinical trials; and a sizeable share believed either that the vaccines contain live coronavirus (10%) or were unsure (38%), a proxy for fears that vaccination itself may cause infection. These misconceptions were particularly acute among Republicans, Blacks, individuals with lower levels of educational attainment, and unvaccinated individuals. Perceived side effect severity and underestimating the size of the clinical trials were both significantly associated with vaccine hesitancy.

Romanian Medical Students' Attitude towards and Perceived Knowledge on COVID-19 Vaccination

In Romania, the first phase of the COVID-19 vaccination campaign prioritized medical personnel, which included healthcare students. This study aimed to assess their knowledge, attitudes towards, and perception of COVID-19 vaccination. An anonymous, single-answer, 42-item online survey was conducted from 12 January until 3 March 2021, in the country’s largest University of Medicine and Pharmacy. Among the 1581 respondents (14.9% response rate), 88.5% were pro-vaccination, 7.8% were undecided, and 3.7% were vaccine resistant. The main reason for vaccine rejection was the perceived speed of vaccine development (strong agreement among the vaccine resistant, moderate agreement among the undecided, p < 0.001). Concern over long-term adverse reaction was present in only 11.5% of the respondents, significantly more frequent in the undecided and vaccine resistant. Perceived knowledge on the vaccines’ safety, efficacy, and technology correlated with a pro-vaccine attitude (p < 0.001). Most respondents had a positive stance towards vaccination in general, influencing their behaviour as future parents (99.3% of the pro-vaccination, 95.1% of the undecided, and 89.1% of the vaccine resistant will vaccinate their children, p < 0.001) and as medical professionals (99.7% of the pro-vaccination, 93.5% of those undecided, and 89.8% of the vaccine resistant would advise parents to vaccinate their children, p < 0.001). Healthcare students can thus serve as important vectors for scientifically sound information, influencing vaccine uptake in the community.

Make it personal to beat vaccine hesitancy

A randomized controlled trial found that vaccine hesitancy for COVID-19 is most effectively addressed with information on personal benefits of vaccination.

Interim Estimates of COVID-19 Vaccine Effectiveness in a Mass Vaccination Setting: Data from an Italian Province

This retrospective cohort study compared the rates of virologically-confirmed SARS-CoV-2 infections, symptomatic or lethal COVID-19 among the residents of the Italian province of Pescara who received one or two doses of COVID-19 vaccines, versus the unvaccinated. The official data of the National Health System were used, and a total of 69,539 vaccinated adults were compared with 175,687 unvaccinated. Among the subjects who received at least one vaccine dose, 85 infections (0.12%), 18 severe and 3 lethal COVID-19 cases were recorded after an average follow-up of 38 days. Among the unvaccinated, the numbers were 6948 (4.00%), 933 (0.53%) and 241 (0.14%), respectively. The serious adverse event reports-yet unconfirmed-were 24 out of 102,394 administered doses. In a Cox model, adjusting for age, gender, and selected comorbidities, the effectiveness of either BNT162b2, ChAdOx1 nCoV-19 or mRNA-1273 vaccines was higher than 95% in preventing infections (mostly due to B.1.1.7 variant), symptomatic or lethal COVID-19. No differences were observed across genders, and among the 691 subjects who received the second dose of vaccine later than the recommended date. Although preliminary, these findings support current immunization policies and may help reducing vaccine hesitancy.

Who Influences the Public Intention to Get a COVID-19 Vaccine and What are the Public References and Concerns? A Population Survey in Vietnam

Background

Coronavirus disease 2019 (COVID-19) vaccine acceptance is influenced by the trusted recommenders. This survey examined the public references, concerns, and trust in seven groups of recommenders regarding COVID-19 vaccine in Vietnam.

Materials and Methods

A cross-sectional survey was conducted on 1,579 participants between April 16 and July 16, 2021. Participants’ references, concerns, and responses to vaccination recommendations made by government officials, employers, physicians, nurses, pharmacists, senior family members, and religious leaders were captured using a self-administered questionnaire.

Results

Rates of trust ranged from 18.5% to 89.1%. The highest rates were attributable to government (89.1%) and physicians (85.9%). Less than half of participants would accept the vaccines if pharmacists (45.5%), nurses (44.7%), employers (42.4%), senior family members (28.1%), and religious leaders (18.4%) recommended it. Only 37.6% of participants thought that vaccines were safe for them, while 57% were unsure. Most participants would wait and see how people respond to the vaccines before getting vaccinated (91.5%), preferred to receive the vaccines at public hospitals (88.6%), and were concerned about vaccine effectiveness (86.9%) and side effects (76.4%), while 61.8% were concerned about vaccine cost.

Conclusion

Focusing on the personal benefit and relying on the government, physicians, and social role models would make the vaccine advertising campaigns more effective. If annual vaccinations were needed, providing the community with affordable vaccines would be an appropriate, long-term solution to ensure vaccination coverage in low-resource countries like Vietnam. Further studies are needed to examine reasons for the public reference of vaccination centers which may help in improving their confidence in getting the vaccine, regardless of the settings.