'Vaccine hesitancy' among university students in Italy during the COVID-19 pandemic

Factors influencing nursing students' intention to accept COVID-19 vaccination: A pooled analysis of seven European countries

BACKGROUND

Experiencing the third wave of COVID-19 pandemic, high vaccination coverage by a safe and effective vaccine globally would be a great achievement. Acceptance of vaccination by nursing students is an important issue as they play a decisive role as future professionals in educating patients, counselling, and guiding them to the right clinical decision.

OBJECTIVES

To explore the intention of nursing students to get vaccinated for SARS-CoV-2 infection and the factors acting either as motivators or as barriers towards vaccination.

DESIGN

A multicenter cross-sectional design.

PARTICIPANTS

In total 2249 undergraduate nursing students participated.

METHODS

The study was conducted in 7 universities in participating countries (Greece, Albania, Cyprus, Spain, Italy, Czech Republic, and Kosovo) through a web survey. Data was collected during December 2020-January 2021 in all countries.

RESULTS

Forty three point 8% of students agreed to accept a safe and effective COVID-19 vaccine, while the acceptance was higher among Italian students. The factors for intention to get vaccinated were male gender (p = 0.008), no working experience in healthcare facilities during the pandemic (p = 0.001), vaccination for influenza in 2019 and 2020 (p < 0.001), trust in doctors (p < 0.001), governments and experts (p = 0.012), high level of knowledge (p < 0.001) and fear of COVID-19 (p < 0.001).

CONCLUSIONS

Understanding of factors that influence students' decision to accept COVID-19 vaccination could increase the acceptance rate contributing to a management of the pandemic.

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.

Prevalence and Drivers of COVID-19 Vaccine Hesitancy among Czech University Students: National Cross-Sectional Study

Background: university students are believed to retain the highest levels of health literacy. They are perceived as the opinion leaders within their communities; therefore, their health-related beliefs and attitudes are deemed important for public health campaigns. This study aimed to investigate the COVID-19 vaccine hesitancy drivers among university students in the Czech Republic. Methods: a cross-sectional study using a self-administered questionnaire was carried out in the weeks before the unrestricted vaccine deployment to Czech adults. The questionnaire had 21 multiple-choice items stratified in 4 categories; demographic characteristics, COVID-19-related anamnesis and influenza vaccine experience, attitudes towards COVID-19 vaccination, and the possible drivers of COVID-19 vaccine hesitancy suggested by the WHO-SAGE. Results: out of the 1351 included students, 66.8% were females, 84.5% were Czech nationals, and 40.6% enrolled in healthcare programs. The overall COVID-19 vaccine acceptance level was 73.3%, 19.3% of participants were vaccine-resistant, and only 7.4% were vaccine-hesitant. Trust in the pharmaceutical industry, trust in healthcare providers, and perceived knowledge sufficiency predicted higher odds of vaccine acceptance. In contrast, media and social media, personal beliefs, immunity misconception, previous COVID-19 infection, and suspicions about novel vaccines and the local availability predicted higher odds of vaccine hesitancy. Conclusions: The findings of this study predict a fair probability to achieve community immunity (herd immunity) among the target population group. The primary prevention strategies in the Czech Republic need to be culturally sensitive and inclusive for foreign nationals. As one-quarter of the participating students are dependent on vaccine safety data, this study findings support the call for independent studies evaluating the side effects of COVID-19 vaccines.

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.

COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries

Vaccine hesitancy forms a critical barrier to the uptake of COVID-19 vaccine in high-income countries or regions. This review aims to summarize rates of COVID-19 hesitancy and its determinants in high-income countries or regions. A scoping review was conducted in Medline®, Embase®, CINAHL®, and Scopus® and was reported in accordance with the PRISMA-SCr checklist. The search was current as of March 2021. Studies which evaluated COVID-19 vaccine hesitancy and its determinants in high-income countries (US$12,536 or more GNI per capita in 2019) were included. Studies conducted in low, lower-middle, and upper-middle income countries or regions were excluded. Factors associated with vaccine hesitancy were grouped into four themes (vaccine specific, individual, group, or contextual related factors). Of 2237 articles retrieved, 97 articles were included in this review. Most studies were conducted in U.S. (n = 39) and Italy (n = 9). The rates of vaccine hesitancy across high-income countries or regions ranged from 7-77.9%. 46 studies (47.4%) had rates of 30% and more. Younger age, females, not being of white ethnicity and lower education were common contextual factors associated with increased vaccine hesitancy. Lack of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19, lesser fear of COVID-19, believing that COVID-19 is not severe and not having chronic medical conditions were most frequently studied individual/group factors associated with increased vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine hesitancy included beliefs that vaccine are not safe/effective and increased concerns about rapid development of COVID-19 vaccines. Given the heterogeneity in vaccine hesitancy definitions used across studies, there is a need for standardization in its assessment. This review has summarized COVID-19 vaccine hesitancy determinants that national policymakers can use when formulating health policies related to COVID-19 vaccination.

Hesitant or Not Hesitant? A Systematic Review on Global COVID-19 Vaccine Acceptance in Different Populations

Vaccination currently appears to be the only strategy to contain the spread of COVID-19. At the same time, vaccine hesitancy (VH) could limit its efficacy and has, therefore, attracted the attention of Public Health Systems. This systematic review aimed at assessing anti-COVID-19 vaccine acceptance rates worldwide and at identifying populations more prone to vaccine hesitancy, for which specific interventions should be planned. PubMed database was searched using a purposely formulated string. One hundred out of the 9243 studies retrieved were considered pertinent and thus included in the analyses. VH rate was analyzed according to patient geographical origin, ethnicity, age, study setting, and method used for data collection; data from specific populations were separately analyzed. Overall, this study demonstrated significant differences in terms of VH in the general population and in the specific subgroups examined according to geographical, demographic factors, as well as associated comorbidities, underlining the need for purposely designed studies in specific populations from the different countries, to design targeted programs aimed at increasing awareness for confidence and complacency toward COVID-19 vaccines.

General attitudes toward and awareness of vaccines among students at a university in Northern Cyprus

Misinformation and movements against vaccines put public health at risk. This study investigated vaccine awareness and opinions on the anti-vaccination movement among students at three faculties of Eastern Mediterranean University. Data were collected by questionnaire. Exposure to anti-vaccination propaganda increased proportionally with the size of the cities where participants were born. In total, 88.6% of the participants declared that they planned to vaccinate their children, while those who did not cited various reasons including the belief that vaccines do not work, that vaccines are harmful, and that it is better to be infected naturally. 60.6% of participants reported that they would get vaccinated against SARS-CoV-2 if there was an effective vaccine. Meanwhile, 24.5% of participants were not sure whether would get vaccinated even if it were possible, 11.4% of participants stated that they would not vaccinate their children for a variety of reasons. These results are important, especially in the context of a pandemic, because students will become leaders in education, business, and media, and thus shape the thoughts and opinions of future generations. The anti-vaccination movement is building momentum, and is especially influential in big cities; therefore, it is vital to change our approach to informing students about vaccination.

University students' perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: A multi-methods study

PURPOSE

To investigate university students' willingness to receive a COVID-19 vaccine when it becomes available to them.

METHOD

A multi-methods approach was used-online convenience sample surveys and semi-structured interviews-of young adults attending a large Canadian public university. Two survey samples were collected (June 20-July 28, 2020 and September 22-October 17, 2020). Semi-structured interviews were conducted following each survey, interviewing 20 students in each round.

RESULTS

In June 77.8% of surveyed students (n = 483) were willing to get the COVID-19 vaccine; in September 79.6% were willing (n = 1269). Multinomial and binary logistic regression analyses found that increasing perception of the severity of COVID-19 predicted the likelihood that a respondent was willing to get the COVID-19 vaccine in both surveys. In the latter survey students who indicated they would be encouraged to get the COVID-19 vaccine if their doctor/pharmacist recommended it were 76 times more likely to be willing to get the vaccine than those who would not be encouraged by medical advice. Interviews revealed concerns about the speed of the vaccine roll out, safety, and efficacy.

CONCLUSIONS

The majority of university students intend to get the COVID-19 vaccine, but there are nuanced concerns about efficacy and safety that must be taken into account by public health authorities as the vaccine becomes available to this group. Ensuring that family doctors, pharmacists, and other front-line healthcare workers have consistent and clear information regarding the benefits of vaccination will be critical to encouraging uptake among young adults.

Pediatricians' COVID-19 experiences and views on the willingness to receive COVID-19 vaccines: a cross-sectional survey in Turkey

Developing an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1-2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement.

COVID-19 vaccine hesitancy: A community-based research in Turkey

AIM

The frequency of vaccine refusal and hesitation, which is associated with many factors, is increasing worldwide. The purpose of this study is to estimate the frequency of vaccine refusal against COVID-19 vaccines and to identify the underlying factors for refusal or hesitation.

MATERIALS AND METHODS

This is a cross-sectional study carried out in a district of Istanbul from 25 to 30 December 2020. A sample of people from the ages of 20 to 85 in the district was selected, and a total of 384 people were enrolled. A questionnaire about the COVID-19 vaccine was administered to the participants by phone. The questionnaire consisted of questions about the sociodemographic characteristics of participants and their thoughts about possible COVID-19 vaccines.

RESULTS

45.3% of the participants were hesitant about getting the COVID-19 vaccine, which was declared appropriate by the Ministry of Health. The rate of those who think that the COVID-19 vaccine will be effective in preventing and controlling the disease was 51.6%. 89.6% of the participants were hesitant about getting their children vaccinated. Those who do not consider COVID-19 disease as a risk to their health were 22.9%, and 32.8% thought that they would be protected from the disease by natural and traditional ways. The median score of the participants' risk perception was 7 (IQR: 6-8; Mean: 6.8; SD: 1.7). The median value of risk perception score of those who accept the vaccine was 6 (IQR: 4-6), while the median value for those who did not accept the vaccine was 4 (IQR: 4-6) (P < .01). Factors affecting vaccine acceptance were determined as the perception of risk (OR: 1.26% 95CI 1.03-1.55) and age (OR: 0.94% 95CI: 0.91-0.98) in logistic regression analysis.

CONCLUSION

Half of the participants were hesitant about the COVID-19 vaccines. The success of COVID-19 vaccination programmes largely depends on the public willingness to accept the vaccine.

Reasons for being unsure or unwilling regarding intention to take COVID-19 vaccine among Japanese people: A large cross-sectional national survey

Background

Identifying and understanding reasons for being unsure or unwilling regarding intention to be vaccinated against coronavirus disease (COVID-19) may help to inform future public health messages aimed at increasing vaccination coverage. We analyzed a broad array of individual's psychological dispositions with regard to decision-making about COVID-19 vaccination in Japan.

Methods

A nationally representative cross-sectional web survey was conducted with 30053 Japanese adults aged 20 years or older at the end of February 2021. In addition to the question on the individual's intention to be vaccinated against COVID-19, respondents were asked about their sociodemographic, health-related, and psychological characteristics as well as information sources about COVID-19 and their levels of trust. Also, those who responded ‘not sure’ or ‘no’ regarding intention to take COVID-19 vaccine were asked why. Multinomial logistic regression with sparse group Lasso (Least Absolute Shrinkage and Selection Operator) penalty was used to compute adjusted odds ratios for factors associated with the intention (not sure/no versus yes).

Findings

The percentages of respondents who answered ‘not sure’ or ‘no’ regarding intention to be vaccinated against COVID-19 vaccine were 32.9% and 11.0%, respectively. After adjusting for covariates, the perceived risks of COVID-19, perceived risk of a COVID-19 vaccine, perceived benefits of a COVID-19 vaccine, trust in scientists and public authorities, and the belief that healthcare workers should be vaccinated were significantly associated with vaccination intention. Several sources of information about COVID-19 were also significantly associated with vaccination intention, including physicians, nurses, and television, medical information sites with lower odds of being unsure or unwilling, and internet news sites, YouTube, family members, and scientists and researchers with higher odds. The higher the level of trust in television as a source of COVID-19 information, the higher the odds of responding ‘not sure’ (odds ratio 1.11, 95% confidence interval 1.01–1.21). We also demonstrated that many respondents presented concerns about the side effects and safety of a COVID-19 vaccine as a major reason for being unsure or unwilling. To decide whether or not to get the vaccine, many respondents requested more information about the compatibilities between the vaccine and their personal health conditions, whether other people had been vaccinated, the effectiveness of vaccines against variants, and doctors’ recommendations.

Interpretation

Our findings suggest that public health messaging based on the sociodemographic and psychological characteristics of those who are unsure or unwilling regarding intention to be vaccinated against COVID-19 vaccine may help to increase vaccine uptake amongst this population.

Funding

The present work was supported in part by a grant from the Ministry of Health, Labour and Welfare of Japan (H29-Gantaisaku-ippan-009).

COVID-19 vaccination intention and influencing factors among different occupational risk groups: a cross-sectional study

As an effective measure to manage the Coronavirus disease 2019 (COVID-19) pandemic, the acceptance of the COVID-19 vaccine and understanding the influencing factors of vaccination intention is particularly important. This study aimed to describe the COVID-19 vaccination intention among three different occupational risk groups and identify influencing factors of vaccination intention since a COVID-19 vaccine is available in China. A cross-sectional questionnaire survey was conducted from January 10 to February 5, 2021 in Hangzhou city of Zhejiang Province, an eastern coastal province in China. The intention to accept COVID-19 vaccination and health beliefs based on the Health Belief Model were collected. Of the participants, college students reported the lowest COVID-19 vaccination intention (64.6%), followed by public transportation workers (72.4%) and health care workers (79.9%). Perceived barriers were identified as negative factors of vaccination intention among all three occupational groups. For college students and public transportation workers, perceived benefits and cues to action were identified as protective factors, and cues to action had a positive effect on vaccination intention of health care workers. Tailored interventions are encouraged to reduce barriers of vaccination, improve health beliefs and promote COVID-19 vaccination intentions.

COVID-19 Vaccination: Concerns About Its Accessibility, Affordability, and Acceptability

By the mid of June 2021, after an almost 1.5-year-long COVID-19 pandemic that has significantly affected the world in multiple ways, various vaccines against COVID-19 have arrived and started worldwide. Yet, economic, (geo)political, and socio-cultural factors may influence its uptake at individual and country levels. Several issues will (and already have been reported in media) revolve around this vaccination regarding its accessibility, affordability, and acceptability at an individual level and a country level. Given that in this commentary, we provoke a discussion: Who—a country as well as the individuals—would have access to it, and who would economically afford it, and who would accept it? Centering these intriguing questions, we revisit the body of literature that explicates vaccine hesitancy, refusal, and resistance, and we also draw on the current literature and media reports about vaccination against COVID-19. We suggest that these backdrops need essential attention so that everyone can afford, accept, and have access to it. Otherwise, the current risk in the face of a year-old pandemic will continue.

Integrating Health Behavior Theories to Predict COVID-19 Vaccine Acceptance: Differences between Medical Students and Nursing Students

BACKGROUND

This study aimed to explore behavioral-related factors predicting the intention of getting a COVID-19 vaccine among medical and nursing students using an integrative model combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB).

METHODS

A cross-sectional online survey was conducted among medical and nursing students aged > 18 years in their clinical years in Israel between 27 August and 28 September 2020. Hierarchical logistic regression was used to predict acceptance of a COVID-19 vaccine.

RESULTS

A total number of 628 participants completed the survey. Medical students expressed higher intentions of getting vaccinated against COVID-19 than nursing students (88.1% vs. 76.2%, p < 0.01). The integrated model based on HBM and TPB was able to explain 66% of the variance (adjusted R2 = 0.66). Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived susceptibility, benefits, barriers, cues to action, attitude, self-efficacy and anticipated regret. Two interaction effects revealed that male nurses had a higher intention of getting vaccinated than did female nurses and that susceptibility is a predictor of the intention of getting vaccinated only among nurses.

CONCLUSIONS

This study demonstrates that both models considered (i.e., HBM and TPB) are important for predicting the intention of getting a COVID-19 vaccine among medical and nursing students, and can help better guide intervention programs, based on components from both models. Our findings also highlight the importance of paying attention to a targeted group of female nurses, who expressed low vaccine acceptance.

What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis

Examine the factors that promote vaccine hesitancy or acceptance during pandemics, major epidemics and global outbreaks. A systematic review and thematic analysis of 28 studies on the Influenza A/H1N1 pandemic and the global spread of Ebola Virus Disease. We found seven major factors that promote vaccine hesitancy or acceptance: demographic factors influencing vaccination (ethnicity, age, sex, pregnancy, education, and employment), accessibility and cost, personal responsibility and risk perceptions, precautionary measures taken based on the decision to vaccinate, trust in health authorities and vaccines, the safety and efficacy of a new vaccine, and lack of information or vaccine misinformation. An understanding of participant experiences and perspectives toward vaccines from previous pandemics will greatly inform the development of strategies to address the present situation with the COVID-19 pandemic. We discuss the impact vaccine hesitancy might have for the introduction and effectiveness of a potential COVID-19 vaccine. In particular, we believe that skepticism toward vaccines can still exist when there are no vaccines available, which is contrary to contemporary conceptualizations of vaccine hesitancy. We recommend conducting further research assessing the relationship between the accessibility and cost of vaccines, and vaccine hesitancy.

Factors associated with the intention of Syrian adult population to accept COVID19 vaccination: a cross-sectional study

Background and objectives

With global efforts to develop and deliver a COVID-19 vaccine rapidly, vaccine hesitancy stands as a barrier to these efforts. We aimed to estimate the proportion of Syrian adult population intending to be vaccinated against COVID-19 and, principally, to assess the demographic and attitudinal factors associated with it in order to approach suitable solutions.

Methods

An anonymous online questionnaire was conducted between 23rd December 2020 and 5th January 2021 in various provinces in Syria. A total of 3402 adults were sampled to reflect the population demographic factors. Attitudinal factors included Covid-19 fears, risks, and beliefs on the origin. Vaccination hesitancy and knowledge were also measured. The intention to get vaccinated against COVID-19 was the primary endpoint.

Results

According to their statements, 1222 participants (35.92%) will consent to get vaccinated against COVID-19. Our findings indicate that male gender, younger age, rural residence, not having children, smoking, fear about COVID-19, individual perceived severity, believing in the natural origin of the coronavirus, and high vaccination knowledge were positive predictors of embracing COVID-19 vaccine when it is available.

Conclusion

COVID-19 vaccine acceptance rate is considerably poor across Syrian population compared to populations in developed countries. Vaccine hesitancy is closely bound to the fear of side effects and doubts about vaccine efficacy. Factors such as conspiracy beliefs and myths about the vaccine lower vaccine uptake. Thus, interventional educational campaigns are increasingly required to overcome misinformation and avert low vaccination acceptance rates.

Public health ethics and the COVID-19 pandemic

Health is a human right anchored in values as a basic necessity of life. It promotes the well-being of persons, communities, economic prosperity, and national development. The coronavirus disease-2019 (COVID-19) pandemic caught the world unaware and unprepared. It presented a huge challenge to the health and economic systems of every country. Across the spectrum of human endeavor and liberty, several ethical questions have been raised with regard to its management, particularly the public health control measures. Decisions for pandemic control measures are made under difficult circumstances driven by urgency and panic, with uncertainties and complexities for public goods over individual rights. Global solidarity in controlling the pandemic is being tested. National governments have the responsibility to protect public health on the grounds of common good. Political considerations should not be the basis for decision-making against the best available epidemiological data from pandemic disease dynamics. Hence, the need to adhere to the values of honesty, trust, human dignity, solidarity, reciprocity, accountability, transparency, and justice are major considerations. A literature search was conducted for the publications from academic databases and websites of health-relevant organizations. I discuss the ethical questions and challenges of the COVID-19 pandemic in the context of public health control measures using the standard ethical principles of respect for autonomy, beneficence, nonmaleficence, and social (distributive) justice. It is observed that, at the country level, the World Health Organization (WHO) guidelines are used to control the pandemic. As WHO through the COVAX strategy distributes the vaccines to less developed countries, a lot still needs to be done to address the complex bottlenecks of allocation and distribution. There is a need to ensure acceptable and transparent system that promotes cooperation, equitable access, and fair distribution of vaccines on a global scale.

Prevalence and predictors of anxiety, depression and stress among university students during the period of the first lockdown in Germany

BACKGROUND

The COVID-19 pandemic exacerbates the risk for mental health issues of university students. The aims of the study were to investigate the prevalence of anxiety, depression and stress among university students during the period of the first lockdown in Germany, and the associations of possible risk and protective factors with all three outcome variables.

METHODS

A total of 2.548 university students were included in the study. The study took place during the period of the first lockdown in Germany. Multiple hierarchical regression analyses were conducted to explore the role of demographic variables, personality traits, psychological capital variables, mindfulness, COVID-19 related variables, and coping strategies on anxiety, depression and stress.

RESULTS

Results showed on average mild depressive and anxiety symptoms, and moderate perceived stress among the students. Alarmingly, 35.9% of the students showed a moderate-to-severe level of depression, 27.7% reported moderate to severe symptoms of anxiety, and 25.1% perceived high stress. Mindfulness and optimism were the most relevant protective factors against depression, anxiety and stress, whereas COVID-related stressors (e.g., worries about study and financial problems, being stressed by the Corona-pandemic and media reporting, quarantine experience) as well as personal characteristics (e.g., neuroticism, older age, being female) were risk factors for increasing mental health issues and/ or stress.

CONCLUSION

The pandemic has negatively affected the mental health of students. The results emphasize the importance of both professional help for students with mental health problems and effective prevention programs on university campuses that promote coping skills, and mental health during the current pandemic.

Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students

BACKGROUND

Vaccine hesitancy poses serious challenges for achieving coverage for population immunity. It is necessary to achieve high COVID-19 vaccination acceptance rates and medical students' coverage as future health care providers. The study aimed to explore the level of COVID-19 vaccine hesitancy and determine the factors and barriers that may affect vaccination decision-making.

METHODS

A cross-sectional study was carried out among medical students in Tanta and Kafrelsheikh Universities, Egypt. Data collection was done via an online questionnaire during January 2021 from 2133 students.

RESULTS

The majority of the participant students (90.5%) perceived the importance of the COVID-19 vaccine, 46% had vaccination hesitancy, and an equal percentage (6%) either definitely accepted or refused the vaccine. Most of the students had concerns regarding the vaccine's adverse effects (96.8%) and ineffectiveness (93.2%). The most confirmed barriers of COVID-19 vaccination were deficient data regarding the vaccine's adverse effects (potential 74.17% and unknown 56.31%) and insufficient information regarding the vaccine itself (72.76%).

CONCLUSION

The government, health authority decision-makers, medical experts, and universities in Egypt need to work together and make efforts to reduce hesitancy and raise awareness about vaccinations, consequently improving the acceptance of COVID-19 vaccines.

Influenza Vaccination Coverage and Intention to Receive Hypothetical Ebola and COVID-19 Vaccines among Medical Students

The study aimed to determine influenza vaccine uptake among medical students and their intention to receive a hypothetical Ebola or COVID-19 vaccine. This cross-sectional questionnaire-based study was performed in 2015 and 2020 on 675 medical students at the Medical University of Warsaw, Poland. In 2020, the influenza vaccination coverage was 36.5%, and students were almost five times more likely to be vaccinated than in 2015 (OR = 4.8; 95% CI: 3.1-7.5). In 2020, the survey was conducted during the first university campaign targeted at free influenza vaccinations for all students, as well as during the first lockdown in Poland due to the COVID-19 pandemic. In 2020, clinical students (4th-6th study year) were significantly more often vaccinated than preclinical students (p < 0.001), in contrast to 2015. A majority-67.0% and 94.6%-of students expressed their intention to receive a hypothetical Ebola or COVID-19 vaccine, respectively. Among the medical students, influenza vaccination status was a predictor of the intention to receive a COVID-19 vaccine. Influenza vaccine uptake among medical students has increased significantly, but it is still not optimal; thus, further educational efforts are needed to convince those who are hesitant regarding vaccines. A high number of students reported their intention to receive a COVID-19 vaccine, and it is crucial to support their positive attitude about it.

Odds Ratio Estimation of Medical Students' Attitudes towards COVID-19 Vaccination

This study investigated the attitudes of Slovak medical students to COVID-19 vaccination. A cross-sectional study was conducted between 10 March 2021 and 24 March 2021, as the second wave of coronavirus spread in Slovakia. It was performed in four medical faculties with students in years 1-6. An online anonymous questionnaire was distributed through official university platforms. The survey was completed by 1228 of 5374 medical students. The vaccinated group of students had received at least one dose of the COVID-19 vaccine. The study was conducted on 1228 students, of which 880 (71.7%) were vaccinated and 348 unvaccinated (28.3%). The median age was 22 years (range 18-33 years), and 70.6% were women. The lowest vaccination rate was among first (32.7%) and second-year students (61.6%), students living at home with their family (63.8%) and students living in urban areas (69.8%). Only 22.4% of medical students were concerned about serious side effects from the COVID-19 vaccine, and 38.8% were concerned that the COVID-19 vaccine may not be effective. This study provides key information related to medical student vaccination in Slovakia and education about COVID-19 vaccination.

Socio-Demographics Correlate of COVID-19 Vaccine Hesitancy During the Second Wave of COVID-19 Pandemic: A Cross-Sectional Web-Based Survey in Saudi Arabia

Background: The Coronavirus disease 2019 (COVID-19) pandemic is considered a major global public health threat affecting across the life course and socioeconomic aspects of life. Global acceptance to an effective vaccine is the most anticipated resolution. This study aims to evaluate intent to be vaccinated among public in Saudi Arabia during the second wave of the COVID-19 pandemic.

Methods: A cross-sectional web-based study was designed in Saudi Arabia. Study participants (N = 658) were recruited through snowball sampling. The SurveyMonkey platform was used to record the response. Cross-tabulation was performed by participants' intention to vaccinate against COVID-19 virus with sociodemographic characteristics and respondents' risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of vaccination intention among the study participants.

Results: Six hundred fifty-eight participants completed the survey (females = 47.4%). Of the 658 participants, 351 (53.3%) have shown intent to be vaccinated. Five hundred nineteen (78.8%) of the participants were reported to be at high risk of COVID-19, and 307 (46.6%) were reported to trust the healthcare system in the country. The multivariable analysis shows respondents with a high-risk perception (OR: 2.27, 95% CI: 1.49–3.48); higher trust in the healthcare system (OR: 3.24, 95% CI: 2.32–4.61) was found to be the significant factor affecting the decision in acceptance of the COVID-19 vaccine in Saudi Arabia.

Conclusion: Participants reported high knowledge toward COVID-19 virus, and vaccine developments. About half (46.6%) of the study participants reported refusal/hesitancy toward the vaccine during the second wave of the pandemic in Saudi Arabia. The study highlighted that higher risk perception and higher trust in the healthcare system were found to be the main reasons for participants' intentions behind the vaccination.

The Willingness to Receive COVID-19 Vaccine and Its Associated Factors: "Vaccination Refusal Could Prolong the War of This Pandemic" - A Systematic Review

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, spreads globally, since its declaration by the World Health Organization (WHO) as a COVID-19 pandemic on March 11, 2020. COVID-19 vaccine is a crucial preventive approach that can halt this pandemic. The present systematic review was aimed to assess the level of willingness to receive COVID-19 vaccine and its associated factors.

METHODS

A comprehensive literature search was conducted by using various online databases such as PubMed/MEDLINE, HINARI, EMBASE, Google Scholar, Web of Science, Scopus, African journals, and Google for grey literature which were used to search the related articles up to the period of May 08, 2021.

RESULTS

The overall rate of participants' willingness to receive the COVID-19 vaccine was ranged from 27.7% to 91.3%, which was from Congo and China, respectively. Factors such as age, educational status, gender, income, residency, occupation, marital status, race/ethnicity, perceived risk of COVID-19, trust in healthcare system, health insurance, norms, attitude towards vaccine, perceived benefit of vaccine, perceived vaccine barriers, self-efficacy, up-to-date on vaccinations, tested for COVID-19 in the past, perceived efficacy of the COVID-19 vaccination, recommended for vaccination, political leaning, perceived severity of COVID-19, perceived effectiveness of COVID-19 vaccine, belief that vaccination makes them feel less worried about COVID-19, believing in mandatory COVID-19 vaccination, perceived potential vaccine harms, presence of chronic disease, confidence, COVID-19 vaccine safety concern, working in healthcare field, believing vaccines can stop the pandemic, fear about COVID-19, cues to action, COVID-19 vaccine hesitancy, complacency, and receiving any vaccine in the past 5 years were associated with the willingness of receive COVID-19 vaccine.

CONCLUSION

There were insufficient levels of willingness to receive COVID-19 vaccine, and several factors were associated with it. Health education should be provided concerning this vaccine to improve the willingness of the community.

COVID-19 Vaccine Hesitancy in a Representative Education Sector Population in Qatar

Even though vaccination programs have now started in earnest across the globe and in Qatar, vaccine hesitancy remains a barrier to effectively tackling the pandemic. Many factors influence willingness to take vaccines including safety, efficacy, and side effects. Given their proximity to research and education, university students and employees represent an interesting cohort in which to investigate vaccine hesitancy. The aim of this study was to assess the attitudes of Qatar University employees and students towards the COVID-19 vaccine. In total, 231 employees and 231 students participated in an online cross-sectional study in February 2021. Of the sample, 62.6% were willing to take a vaccine against COVID-19. Participants with or taking postgraduate degrees were more willing to take the vaccine compared to participants with or taking a diploma or bachelor’s degree (p < 0.001). Males had a higher rate of vaccine acceptance (p < 0.001). In the group that regarded flu vaccination as important, 13% were unwilling to take COVID-19 vaccine. There were no associations between willingness to vaccinate and vaccine/virus knowledge and social media use. Participants showed a high level of concern regarding vaccine side effects in themselves or their children. Two-thirds agreed or strongly agreed that they would take the vaccine if it was mandatory for international travel. Our participants were neutral to the origin of vaccine development. These findings, which represent data collected after the start of the national vaccination program, show that vaccine hesitancy persists in the Qatari population and that some groups, such as undergraduate students, could benefit from specific, targeted public health campaigns.

The UPTAKE study: a cross-sectional survey examining the insights and beliefs of the UK population on COVID-19 vaccine uptake and hesitancy

OBJECTIVE

A key challenge towards a successful COVID-19 vaccine uptake is vaccine hesitancy. We examine and provide novel insights on the key drivers and barriers towards COVID-19 vaccine uptake.

DESIGN

This study involved an anonymous cross-sectional online survey circulated across the UK in September 2020. The survey was designed to include several sections to collect demographic data and responses on (1) extent of agreement regarding various statements about COVID-19 and vaccinations, (2) previous vaccination habits (eg, if they had previously declined vaccination) and (3) interest in participation in vaccine trials. Multinominal logistic models examined demographic factors that may impact vaccine uptake. We used principle component analysis and text mining to explore perception related to vaccine uptake.

SETTING

The survey was circulated through various media, including posts on social media networks (Facebook, Twitter, LinkedIn and Instagram), national radio, news articles, Clinical Research Network website and newsletter, and through 150 West Midlands general practices via a text messaging service.

PARTICIPANTS

There were a total of 4884 respondents of which 9.44% were black, Asian and minority ethnic (BAME) group. The majority were women (n=3416, 69.9%) and of white ethnicity (n=4127, 84.5%).

RESULTS

Regarding respondents, overall, 3873 (79.3%) were interested in taking approved COVID-19 vaccines, while 677 (13.9%) were unsure, and 334 (6.8%) would not take a vaccine. Participants aged over 70 years old (OR=4.63) and the BAME community (OR=5.48) were more likely to take an approved vaccine. Smokers (OR=0.45) and respondents with no known illness (OR=0.70) were less likely to accept approved vaccines. The study identified 16 key reasons for not accepting approved vaccines, the most common (60%) being the possibility of the COVID-19 vaccine having side effects.

CONCLUSIONS

This study provides an insight into focusing on specific populations to reduce vaccine hesitancy. This proves crucial in managing the COVID-19 pandemic.

COVID-19 Vaccine Acceptance, Hesitancy, and Resistancy among University Students in France

The objectives were to explore, among university students, the level of COVID-19 vaccine acceptance, hesitancy, and resistancy and to determine the motivations and barriers, and the reasons that may change student vaccination decision making. An online observational cross-sectional study was conducted among students of a French university in January 2021 with questions about the intention to be vaccinated against COVID-19, the motivations and the barriers. The convenience sample included 3089 students, with a mean of age of 20.3 (SD = 1.9). To the question on the intention to vaccinate against the COVID-19, 58.0% of students reported that they would choose to have a vaccination, 17.0% reported that they would not and 25.0% were not sure. The main motivations for vaccine acceptance were "I don't want to transmit COVID-19 to others", the main barriers for vaccine resistance or hesitancy were "I prefer to wait until I have more experience with these new vaccines". Age, female gender, being in first three years of study, studied sciences courses and neither sciences nor healthcare courses of study were significantly associated with a higher risk of vaccine hesitancy or resistancy. Self-estimated knowledge of conventional vaccines and COVID-19 vaccines, and confidence in efficiency and safety of conventional vaccination were associated with a lower risk of vaccine hesitancy or resistancy. It is relevant to disseminate evidence-based interventions to promote COVID-19 vaccine acceptability for college students, especially for the students in neither sciences nor healthcare courses of study, as college students will soon be eligible to receive a COVID-19 vaccine.

Knowledge and Acceptance of COVID-19 Vaccination among Undergraduate Students from Central and Southern Italy

At the end of 2020, the Italian Ministry of Health launched a national vaccination campaign to counteract the COVID-19 pandemic. The present study aimed at appraising levels of knowledge about and acceptance of COVID-19 vaccination in a sample of Italian undergraduates during the first phase of the immunization plan. A web-based questionnaire was administered to students attending universities in Bari, Naples, and Rome during the period February–April 2021. Of the total of 3226 participants, 91.9% were keen to receive a COVID-19 vaccination. More than 80% gave correct answers to questions about COVID-19 vaccine administration, functioning, and effects on community health. However, only 63.8% identified the correct composition of the available vaccines. Knowledge was found to be related to sociodemographic features and COVID-19 vaccination acceptance (p < 0.05). COVID-19 vaccination acceptance was found to be related to having a previous vaccination against influenza (OR 3.806, CI 95% 1.181–12.267; p = 0.025) and knowledge (OR 4.759, CI 95% 2.106–10.753; p = 0.000). These results show a good level of awareness about COVID-19 vaccination in this population, which may indicate the effectiveness of communication strategies accompanying the COVID-19 immunization campaign in Italy.

Perception of Health, Mistrust, Anxiety, and Indecision in a Group of Italians Vaccinated against COVID-19

The objectives of this study were to evaluate the psychological factors of health perception, mistrust, anxiety, fear, and indecision of Italians vaccinated against COVID-19, and conduct an analysis of the relationships between these factors and other variables: sex, vaccine priority ministerial categories, and the type and dose of vaccine. The participants included 1564 subjects who joined the vaccination campaign at the COVID-19 Vaccination Center in Salerno, Italy. A survey was conducted in the reference period March-April 2021 using a brief anamnestic questionnaire. In addition, the following standardized scales were used: the State-Trait Anxiety Inventory (STAI-Y) and the Short Form Health Survey (SF-12). The results showed that, in terms of the type of vaccine received, the interviewees felt more confident in having received the Comirnaty (Pfizer-BioNTech, 23.5%) and Vaxzevria (AstraZeneca, 18.6%) vaccines-feeling less tense (2.1%; Vaxzevria (AstraZeneca) = 3.2%), frightened (1%; Vaxzevria (AstraZeneca) = 1.4%), not at all nervous (61.1%; Vaxzevria (AstraZeneca), 43.6%), and not at all/undecided (67.9%; Vaxzevria (AstraZeneca), 58.6%). Regarding the mood and psychological states considered at the different vaccine administration times, other important differences emerged as the interviewees reported higher levels of tension, nervousness, and fear during the first phase of vaccine administration. Specifically, 40.7% (second dose, 32.7%) felt somewhat tense at the first dose, 26.4% felt frightened (second dose, 21.8%), and 33.8% felt nervous (second dose, 26.8%). The perceived state of health also increased at the end of the vaccination cycle, as, at the second dose, 15.4% of the sample reported an evaluation of "excellent" (first dose, 12.4%).

Vaccine Acceptance and Its Influencing Factors: An Online Cross-Sectional Study among International College Students Studying in China

BACKGROUND

With the continuous large-scale development of the COVID-19 vaccine, the acceptance of vaccination and its influencing factors at the individual level have become crucial to stemming the pandemic. This study aims to explore the factors that influence the acceptance of the COVID-19 vaccine among international college students.

METHODS

The target population constituted international students pursuing various degrees in Jiangsu Province through an online cross-sectional study. A cluster random sampling was performed using a self-administered questionnaire. The Health Belief Model and Knowledge, Attitude/Beliefs, and Practice Theory served as the underlying theories to understanding the factors that influence vaccine acceptance.

RESULTS

We received 330 responses. About 36.4% intended to accept the vaccine. The acceptance varied across respondents' place of residence, program of study, continent of origin, knowledge, susceptibility, severity, benefits, and cues to action (p < 0.05). A multivariable logistics regression revealed cues to action (p < 0.001), the perception of COVID-19 vaccination benefits (p = 0.002), and the perception of barriers (p < 0.001) that were associated with vaccine acceptance.

CONCLUSIONS

The acceptance of the COVID-19 vaccine was low among international students. The correct and comprehensive beliefs of the target groups regarding the benefits and barriers of the vaccination must be raised. Various effective social strategies must be adopted to trigger the intention of COVID-19 vaccination. The study findings will inform the decisions of public health campaigners, aimed at reducing vaccine hesitation when the COVID-19 vaccine is widely available.

Global Prevalence and Drivers of Dental Students' COVID-19 Vaccine Hesitancy

BACKGROUND

Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students' acceptance levels.

METHODS

A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE.

RESULTS

A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17-40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; p < 0.01).

CONCLUSIONS

The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.

COVID-19 vaccine hesitancy among medical students in India

The coronavirus disease 2019 (COVID-19) vaccine was launched in India on 16 January 2021, prioritising health care workers which included medical students. We aimed to assess vaccine hesitancy and factors related to it among medical students in India. An online questionnaire was filled by 1068 medical students across 22 states and union territories of India from 2 February to 7 March 2021. Vaccine hesitancy was found among 10.6%. Concern regarding vaccine safety and efficacy, lack of awareness regarding their eligibility for vaccination and lack of trust in government agencies predicted COVID-19 vaccine hesitancy among medical students. On the other hand, the presence of risk perception regarding themselves being affected with COVID-19 reduced vaccine hesitancy as well as hesitancy in participating in COVID-19 vaccine trials. Vaccine-hesitant students were more likely to derive information from social media and less likely from teachers at their medical colleges. Choosing between the two available vaccines (Covishield and Covaxin) was considered important by medical students both for themselves and for their future patients. Covishield was preferred to Covaxin by students. Majority of those willing to take the COVID-19 vaccine felt that it was important for them to resume their clinical posting, face-to-face classes and get their personal life back on track. Around three-fourths medical students viewed that COVID-19 vaccine should be made mandatory for both health care workers and international travellers. Prior adult vaccination did not have an effect on COVID-19 vaccine hesitancy. Targeted awareness campaigns, regulatory oversight of vaccine trials and public release of safety and efficacy data and trust building activities could further reduce COVID-19 vaccine hesitancy among medical students.

Psychological factors affecting COVID-19 vaccine hesitancy

Background

Vaccine hesitancy is an important public health problem.

Aims

Identifying and understanding COVID-19 vaccine hesitancy may aid future public health messaging. This study, in which we planned to study the determinants of COVID-19 vaccine hesitancy, aims to reveal the relationship between “intolerance of uncertainty,” “belief in conspiracy theories,” and “COVID-19 phobia” with vaccine hesitancy.

Methods

This is a cross-sectional study conducted during a COVID-19 outbreak. Participants were reached via various social media platforms and e-mailing lists for convenience. Data were collected with an online survey using SurveyMonkey application. “Intolerance of Uncertainty Scale (IUS-12),” “Conspiracy Mentality Scale (CMS),” and “COVID-19 Phobia Scale” were applied to 488 participants. Statistical significance level was considered p < 0.05.

Results

Four hundred eighty-eight people between the ages of 18 and 65 participated. Twenty-one participants were excluded from the analysis due to random marking and unreasonable filling times (< 10 min). In this way, analyzes were made with 467 people. We found a positive correlation between the belief in conspiracy theories and vaccine hesitancy (p < 0.05). And also found that individuals with low fear of COVID-19 would hesitate about vaccination (p < 0.05).

Conclusions

Vaccine hesitancy is an important public health problem, and it puts public health at risk, especially during the epidemic period we live in. Therefore, it is important to understand the psychological factors involved in vaccine hesitancy. It would be useful to look for ways to spread accurate information about the vaccine in a healthier way in this case.

Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda

BACKGROUND

COVID-19 is still a major global threat for which vaccination remains the ultimate solution. Uganda reported 40,751 cases and 335 deaths as of 9 April 2021 and started its vaccination program among priority groups like health workers, teachers, those with chronic diseases among others in early March 2021. Unanimous uptake of the COVID-19 vaccine is required to subsequently avert its spread; therefore, we assessed COVID-19 vaccine acceptability, hesitancy, and associated factors among medical students in Uganda.

METHODS

This study employed an online descriptive cross-sectional survey among medical students across 10 medical schools in Uganda. A structured questionnaire via Google Form was conveniently sent to eligible participants via WhatsApp. Each medical school had a coordinator who consistently shared the data tool in the WhatsApp groups. Chi-square or Fisher's exact test, and logistic regression were used to assess the association between vaccine acceptability with demographics, COVID-19 risk perception, and vaccine hesitancy.

RESULTS

We surveyed 600 medical students, 377 (62.8%) were male. COVID-19 vaccine acceptability was 37.3% and vaccine hesitancy 30.7%. Factors associated with vaccine acceptability were being male (adjusted odds ratio (aOR) = 1.9, 95% CI 1.3-2.9, p=0.001) and being single (aOR= 2.1, 95% CI 1.1-3.9, p=0.022). Very high (aOR= 3.5, 95% CI 1.7-6.9, p<0.001) or moderate (aOR =2.2, 95% CI 1.2-4.1, p=0.008) perceived risk of getting COVID-19 in the future, receiving any vaccine in the past 5 years (aOR= 1.6, 95% CI 1.1-2.5, p=0.017), and COVID-19 vaccine hesitancy (aOR 0.6, 95% CI 0.4-0.9, p=0.036).

CONCLUSIONS

This study revealed low levels of acceptance towards the COVID-19 vaccine among medical students, low self-perceived risks of COVID-19, and many had relied on social media that provided them with negative information. This poses an evident risk on the battle towards COVID-19 in the future especially when these future health professions are expected to be influencing decisions of the general public towards the same.

Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic

BACKGROUND

While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue.

METHODS

We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage.

RESULTS

A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant.

CONCLUSIONS

Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses' perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people.

A Comparison of the Level of Acceptance and Hesitancy towards the Influenza Vaccine and the Forthcoming COVID-19 Vaccine in the Medical Community

Despite research conducted worldwide, there is no treatment specifically targeting SARS-CoV-2 infection with efficacy proven by randomized controlled trials. A chance for a breakthrough is vaccinating most of the global population. Public opinion surveys on vaccine hesitancy prompted our team to investigate Polish healthcare workers' (HCWs) attitudes towards the SARS-CoV-2 and influenza vaccinations. In-person and online surveys of HCWs: doctors, nurses, medical students, and other allied health professionals (n = 419) were conducted between 14 September 2020 and 5 November 2020. In our study, 68.7% of respondents would like to be vaccinated against COVID-19. The safety and efficacy of COVID-19 vaccinations would persuade 86.3% of hesitant and those who would refuse to be vaccinated. 3.1% of all respondents claimed that no argument would convince them to get vaccinated. 61.6% of respondents declared a willingness to receive an influenza vaccination, of which 83.3% were also inclined to receive COVID-19 vaccinations. Although most respondents-62.5% (262/419) indicated they trusted in the influenza vaccine more, more respondents intended to get vaccinated against COVID-19 in the 2020/2021 season. The study is limited by its nonrandom sample of HCWs but provides a preliminary description of attitudes towards SARS-CoV-2 vaccination.

Attitudes Toward COVID-19 Vaccination Among Young Adults in Zurich, Switzerland, September 2020

Objectives: Young adults are essential to the effective mitigation of the novel coronavirus (SARS-CoV-2/COVID-19) given their tendency toward greater frequency of social interactions. Little is known about vaccine willingness during pandemics in European populations. This study examined young people's attitudes toward COVID-19 vaccines in Fall 2020. Methods: Data came from an ongoing longitudinal study's online COVID-19-focused supplement among young adults aged 22 in Zurich, Switzerland (N = 499) in September 2020. Logistic regressions examined young adults' likelihood of participating in COVID-19 immunization programs. Results: Approximately half of respondents reported being unlikely to get vaccinated against COVID-19. Compared to males, females were more likely to oppose COVID-19 vaccination (p < 0.05). In multivariate models, Sri Lankan maternal background and higher socioeconomic status were associated with a greater likelihood of getting vaccinated against COVID-19 (p < 0.05). Respondents were more likely to report a willingness to get vaccinated against COVID-19 when they perceived 1) an effective government response (p < 0.05) and 2) their information sources to be objective (p < 0.05). Conclusion: This study communicates aspects important to the development of targeted information campaigns to promote engagement in COVID-19 immunization efforts.

Healthcare Workers' Perspectives on the Upcoming COVID-19 Vaccine in Terms of Their Exposure to the Influenza Vaccine in Riyadh, Saudi Arabia: A Cross-Sectional Study

In 2019, a novel severe acute respiratory syndrome (SARS-CoV-2 (COVID-19)) caused a global pandemic. There was an urgent need to develop a vaccine against COVID-19 to reduce its spread and economic burden. The main objective of this study was to understand the attitudes and concerns of healthcare workers (HCWs) towards the upcoming COVID-19 vaccine, whether their decision was influenced by their history of taking the seasonal influenza vaccine, and factors that influence the acceptance of the upcoming COVID-19 vaccine. This was a cross-sectional study conducted in Riyadh, Saudi Arabia. We selected and surveyed 356 HCWs via an electronic self-administered questionnaire. A total of 61.16% of HCWs were willing to receive the COVID-19 vaccine, and 55.9% of them had received the seasonal influenza vaccine in the preceding year (2019-2020). The strongest predictors for taking the COVID-19 vaccine were the HCWs' belief that the COVID-19 vaccine would be safe, needed even for healthy people, that all HCWs should be vaccinated against COVID-19, and that HCWs will have time to take the vaccine. Being female, being middle aged, having <5 years of work experience, having no fear of injections, and being a non-smoker were predictive factors for taking the upcoming COVID-19 vaccine. No associations were found between the intention to take the COVID-19 vaccine and a history of taking the seasonal influenza vaccine.

Vaccine hesitancy in the era of COVID-19

OBJECTIVES

In 2019, a new coronavirus has been identified and many efforts have been directed toward the development of effective vaccines. However, the willingness for vaccination is deeply influenced by several factors. So the aim of our review was to analyze the theme of vaccine hesitancy during COVID-19 pandemic, with a particular focus on vaccine hesitancy toward COVID-19 vaccine.

STUDY DESIGN

Narrative review.

METHODS

In November 2020, we performed a search for original peer-reviewed articles in the electronic database PubMed (MEDLINE). The key search terms were "Vaccine hesitancy AND COVID-19". We searched for studies published during COVID-19 pandemic and reporting information about the phenomenon of vaccine hesitancy.

RESULTS

Fifteen studies were included in the review. The percentage of COVID-19 vaccine acceptance was not so high (up to 86.1% students or 77.6% general population); for influenza vaccine, the maximum percentage was 69%. Several factors influenced the acceptance or refusal (ethnicity, working status, religiosity, politics, gender, age, education, income, etc.). The most given reasons to refuse vaccine were as follows: being against vaccines in general, concerns about safety/thinking that a vaccine produced in a rush is too dangerous, considering the vaccine useless because of the harmless nature of COVID-19, general lack of trust, doubts about the efficiency of the vaccine, belief to be already immunized, doubt about the provenience of vaccine.

CONCLUSIONS

The high vaccine hesitancy, also during COVID-19 pandemic, represents an important problem, and further efforts should be done to support people and give them correct information about vaccines.

An Asia-Pacific study on healthcare workers' perceptions of, and willingness to receive, the COVID-19 vaccination

OBJECTIVE

In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine.

METHODS

From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities.

RESULTS

More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis.

CONCLUSIONS

The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.

Behavioural intention of receiving COVID-19 vaccination, social media exposures and peer discussions in China

The study aimed to investigate behavioural intentions to receive free and self-paid COVID-19 vaccinations (BICV-F and BICV-SP) among Chinese university students if the vaccine was 80% effective with rare mild side effects, to examine their associations with social media exposures and peer discussions regarding COVID-19 vaccination, and to explore the mediational role of perceived information sufficiency about COVID-19 vaccination. An online anonymous survey (N = 6922) was conducted in November 2020 in five Chinese provinces. Logistic regression and path analysis were adopted. The prevalence of BICV-F and BICV-SP were 78.1% and 57.7%. BICV-F was positively associated with the frequencies of passive social media exposure (adjusted odds ratio (AOR) = 1.32, P < 0.001), active social media interaction (AOR = 1.13, P < 0.001) and peer discussions (AOR = 1.17, P < 0.001). Indirect effects of the three factors on BICV-F via perceived information sufficiency were all significant (P < 0.001). The direct effect of active social media interaction on BICV-F was significantly negative (P < 0.001). Similar associations/mediations were observed for BICV-SP. The COVID-19 vaccination intention of Chinese university students needs improvement. Boosting social media exposures and peer discussions may raise students' perceived information sufficiency and subsequently increase their vaccination intention. Considering the potential negative effect of active social media interaction, caution is needed when using social media to promote COVID-19 vaccination.

Motivation to Have COVID-19 Vaccination Explained Using an Extended Protection Motivation Theory among University Students in China: The Role of Information Sources

BACKGROUND

The aims of the present study were to examine the prediction of the threat and coping appraisal utilizing an extended protection motivation theory (PMT) for the motivation to have COVID-19 vaccination and the influence of various information sources on coping appraisal among university students in China.

METHODS

The sample comprised 3145 students from 43 universities in China who completed an online survey including PMT constructs as well as constructs added to PMT. The PMT constructs comprised motivation to have COVID-19 vaccination, threat appraisal, and coping appraisal. The extended PMT constructs comprised knowledge about mechanisms and information sources of COVID-19 vaccination.

RESULTS

Perceived severity of COVID-19 was positively associated with motivation to have COVID-19 vaccination. Receiving information concerning COVID-19 vaccination from medical personnel was associated with greater self-efficacy, response efficacy, and knowledge, whereas receiving information concerning COVID-19 vaccination from coworkers/colleagues was associated with less response efficacy and knowledge. Receiving online information concerning COVID-19 vaccination was associated with greater response cost of vaccination efficacy and less knowledge.

CONCLUSIONS

This study supported the prediction of perceived severity in the PMT for motivation to have COVID-19 vaccination among university students in China. Vaccination information sources have different effects on students' coping appraisal of COVID-19 vaccination.

Links between conspiracy beliefs, vaccine knowledge, and trust: Anti-vaccine behavior of Serbian adults

RATIONALE

Immunization is a critical tool in the fight against infectious disease epidemics. Understanding hesitancy towards immunization is even more important nowadays, with the continuous threat of COVID-19 pandemic. Medical conspiracy beliefs, scientific skepticism, as well as low trust in governmental institutions, and evidence-based knowledge all have troubling effects on immunization.

OBJECTIVE

To examine how these factors cross-react to influence vaccine behavior against any vaccine preventable disease (VPD), we hypothesized a model consisting of the belief in conspiracy theories as the predictor, and as the mediators subjective and objective vaccine knowledge, and trust in the health care system and science. The model was tested by examining the vaccine intentions for the children and self for any VPD.

METHODS

Two separate studies were conducted on the representative samples of Serbian population; the first study investigated the intentions for child vaccination and the second study examined the vaccine intentions against any VPD, including adult vaccination. We used path analysis followed by logistic regression to analyze the data.

RESULTS

The results revealed high vaccine hesitancy motivated by the belief in the vaccine conspiracy theories, through its effect on reduced trust in medical science and institutions, and low objective vaccine knowledge.

CONCLUSIONS

The results of this study may be used to implement appropriate policy changes and implementation of the public health campaigns to promote immunization with a wide range of vaccines against common diseases, such as measles, human papillomaviruses, or pertussis, and novel diseases, such as COVID.

Attitudes toward COVID-19 vaccines in Chinese college students

Background: Vaccination is an important preventative measure against the coronavirus disease 19 (COVID-19) pandemic. To implement vaccination and immunization programs effectively, it is essential to investigate public attitudes toward COVID-19 vaccines. This study examined the attitudes of Chinese college students toward COVID-19 vaccines and their associated factors. Methods: A cross-sectional study was conducted in college students nationwide from December 27, 2020 to January 18, 2021. Attitudes toward COVID-19 vaccines and acceptance of future vaccination programs were assessed. Results: Totally, 2,881 college students participated in this survey; of them, 76.3% (95% CI: 74.8% - 77.9%) were willing to accept a COVID-19 vaccine in the future. Multiple logistic analysis revealed that students living in urban (OR=1.409, 95% CI: 1.152 - 1.724, p=0.001) and those studying health-related courses (OR=1.581, 95% CI: 1.291 - 1.935, p<0.001) were more likely to have a positive attitude toward COVID-19 vaccines. In addition, those who were worried about being infected with COVID-19 (very much vs no, OR=1.690, 95% CI: 1.212-2.356, p=0.002), heard previously about COVID-19 vaccines (OR=1.659, 95% CI: 1.268-2.170, p<0.001), believed that vaccines are safe (Yes vs No, OR=3.570, 95% CI: 1.825-6.980), thought that vaccines can protect people from being infected with COVID-19 (Yes vs No, OR=1.957, 95% CI: 1.286-2.979, p=0.002), and had encouraged their family and friends to have a vaccine (Yes vs No, OR=17.745, 95% CI: 12.271-25.660, p<0.001) had higher acceptance of COVID-19 vaccination. Conclusions: A high rate of acceptance of COVID-19 vaccines was found among Chinese college students. However, vaccine uptake may be reduced by concerns about vaccine safety and efficacy. Alleviating these concerns and enhancing public confidence in vaccines are crucial for future immunization programs against the COVID-19 pandemic.

Would Parents Get Their Children Vaccinated Against SARS-CoV-2? Rate and Predictors of Vaccine Hesitancy According to a Survey over 5000 Families from Bologna, Italy

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.

Attitudes and Knowledge of European Medical Students and Early Graduates about Vaccination and Self-Reported Vaccination Coverage-Multinational Cross-Sectional Survey

Vaccination is one of the most useful preventive interventions in healthcare. The purpose of our study was to gain overview of the opinions, knowledge, and engagement in vaccination practices among medical students (MS) and junior doctors (JD) in Europe. The survey was distributed from March 2016 until August 2016 via the e-mail and social media of the European Medical Students' Association. In total, 1821 responses from MS and JD from 34 countries in the European region were analysed. The majority of respondents agreed that vaccines are useful (98.7%) and effective (97.2%). Although the necessity of revaccination was supported by 99.2%, only 68.0% of the respondents went through with it. Even though the potential benefit of the flu vaccination seems to be acknowledged by our participants, only 22.1% of MS and JD declared getting the flu shot every or every other season. MS and JD were in favour of specific mandatory vaccination for medical staff (86.0%) and medical students (82.7%). Furthermore, we analysed the self-reported vaccination coverage of our participants regarding 19 vaccines. Of the respondents, 89.5% claimed to provide advice about vaccination to their friends and family. In conclusion, European MS and JD have a very positive attitude towards vaccination. However, their behaviour and knowledge demonstrate certain gaps which should be further addressed in medical education.

Modification of a vaccine hesitancy scale for use in adult vaccinations in the United States and China

Most research on vaccine hesitancy has focused on parental attitudes toward childhood vaccination, but it will be important to understand dimensions of vaccine hesitancy in the adult population as more adult vaccines are introduced in the future. We modified the Vaccine Hesitancy Scale to target adult vaccines and provide measures of its reliability and validity relative to influenza vaccine uptake and COVID-19 vaccination acceptance in cross-sectional internet surveys in the United States and in China. We assessed the impact of vaccine hesitancy on influenza and COVID-19 vaccination using multivariable regression modeling, which informed concurrent validity of the adult Vaccine Hesitancy Scale (aVHS). Among 1103 participants in the March 2020 China survey, 5.4% would not accept a COVID-19 vaccine, whereas this figure was 18.8% for the March 2020 US survey and 27.3% for the June 2020 US survey. The aVHS exhibits good internal consistency in all three surveys. Models adjusted for age, gender and income level show that prevalence of COVID-19 vaccine acceptance was a fraction as high in those who scored higher on the VHS than those who scored lower on all three surveys. Prevalence of past and future flu vaccine acceptance was a fraction as high in those with higher aVHS scores than those with lower scores. Prevalence of COVID-19 vaccine acceptance is lower in those with higher vaccine hesitancy scores, which supports the scale's concurrent validity. The aVHS exhibits good internal consistency, making it a valid and reliable tool for measuring vaccination uptake.

Impact of COVID-19 infodemic on psychological wellbeing and vaccine hesitancy

Background

With COVID-19 pandemic, the world has witnessed a scenario that is unique compared to any other such pandemic that the world has grappled with. This is primarily owing to the parallel infodemic that the population faced with disinformation and misinformation explosion in several platforms that an individual can access.

Main body

The myriad of information that everyone in the world received acted as double-edged sword as some information helped individuals in allying the anxiety and stigma and motivated them for appropriate COVID-19 behavior; however, on the other hand, the same acted opposite and created a whole lot of negative problems in the community. The misinformation regarding the disease is not only limited to what has happened so far in the realm of prevention and control rather the same is also plaguing the efforts towards effective vaccine uptake.

Conclusion

With the technological and media advancement, it is getting difficult to ward off every misinformation that is getting received at individual end which is obviously detrimental in the efforts toward effective vaccine acceptance; however, measures need to be taken at appropriate level to curb this menace of infodemic to relax the world from the clutch of this pandemic. This article looks at the impact of the misinformation and disinformation on psychological wellbeing and vaccine acceptance and suggests remedial measures.