Understanding vaccine acceptance and demand-and ways to increase them

Barriers and drivers influencing people's behaviour towards COVID-19 public health and social measures in the Netherlands

Background

The disease burden of COVID-19 infection, morbidity, and mortality was unevenly distributed across different population subgroups. A one-size-fits-all approach may not reach all groups. Identifying barriers and drivers that influence behaviour towards COVID-19 public health and social measures (PHSM) is an important step when designing tailored interventions. Using the WHO Tailoring Health Programmes (THP) approach, we performed a situation analysis. The objectives were to identify population subgroups; gain an overview of barriers and drivers to COVID-19 PHSM among subgroups; and interventions and research initiated in the Netherlands.

Study design

A literature scan, interviews and a meeting with experts were held.

Methods

Results were categorised according to the capability, opportunity, and motivation to understand COVID-19 PHSM behaviour.

Results

Different population subgroups have been studied regarding their barriers and drivers for uptake and adherence to COVID-19 PHSM, such as (older) migrant communities. Barriers include language barriers, mis- and disinformation and distrust. Drivers include protecting others and oneself. Network ties play a role, as a barrier and driver. Forty-five interventions and research projects were identified. Several revealed the importance of involving key figures. A lack of monitoring and evaluation of interventions during the pandemic was acknowledged by experts.

Conclusions

The situation analysis reveals that knowledge of the most prevalent barriers and drivers between underserved groups and how to address them with targeted (cost) effective interventions is lacking. With this THP project we aim to develop new or improve existing interventions addressing behaviours towards PHSM among a prioritised population group informed by evidence-based behavioural insights.

Barriers and drivers to exclusive breastfeeding in Kyrgyzstan: a qualitative study with mothers and health workers

BACKGROUND

The WHO/UNICEF global nutrition target for exclusive breastfeeding for six months is at least 70% of infants by 2030. However, global prevalence rates are 48% with variations between countries and within regions. Kyrgyzstan has consistently high early breastfeeding initiation rates, yet exclusive breastfeeding for six months is 46%. This qualitative study addressed two research questions: (1) What are the barriers and drivers for mothers to exclusive breastfeeding in the first six months? (2) What are the barriers and drivers for health workers in primary care facilities to supporting exclusive breastfeeding in the first six months?

METHODS

The study took place from April to June 2023 in five sites (mix of urban and rural). Ten focus group discussions with 40 primary care health workers and 20 in-depth interviews with mothers of a child currently aged 6-12 months who initiated breastfeeding with this child were conducted. Mothers were purposively selected to represent four groups of infant feeding practices in the first six months: (1) exclusive breastfeeding, (2) breastfeeding alongside other fluids/solids, (3) breastfeeding alongside infant formula, (4) breastfeeding followed by switching to formula only. The Capability-Opportunity-Motivation-Behaviour (COM-B) model was the underpinning theoretical framework. Data were analysed using the Framework approach.

RESULTS

The study uncovered important misperceptions amongst mothers who were not exclusively breastfeeding (groups 2-4). These existed alongside a perceived inability to resolve physical challenges of breastfeeding and social pressure to supplement breastmilk with fluids/solids or formula. Half of all mothers felt uncomfortable breastfeeding in public. Health workers were recommending and supporting women with exclusive breastfeeding during multiple antenatal and postnatal interactions during the initial six months. They were knowledgeable and motivated to do this. Moreover, they felt well supported with training, resources, and legislation with just a few mentioning workplace time or space challenges. Very few doctors appeared to currently be meeting with formula industry representatives.

CONCLUSIONS

This theory-informed qualitative study focusing on mother and health worker perspectives provided important insights into the individual and contextual barriers and drivers to exclusive breastfeeding for the first six months in Kyrgyzstan. These insights have informed recommendations for tailored interventions for both groups.

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

Parents' and informal caregivers' experiences of accessing childhood vaccination services within the United Kingdom: a systematic scoping review of empirical evidence

BACKGROUND

Despite repeated calls to action and considerable attention, childhood vaccination uptake has declined for a thirteenth consecutive year in the United Kingdom (UK). Increasingly, stakeholders are advocating for research which goes beyond vaccine hesitancy and explores service accessibility in greater depth. This scoping review aims to identify and critically assess how accessibility is being conceptualised and investigated with a view to informing future research. Research, that in turn, will dictate the interventions pursued to improve vaccination coverage.

METHODS

A detailed search strategy was implemented across seven databases to identify research exploring parents' experiences of accessing childhood vaccination services within the UK. The analysis explored the studies in relation to their conceptualisation of access, methodology, reported results, and recommendations for research or practice using a combination of descriptive qualitative content analysis, typologies, and frequency counts. Methods and reporting adhered to the 'JBI Manual for Evidence Synthesis' and the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews'.

RESULTS

Forty-five studies were included in the analysis. Studies claimed to consider only attitudinal constructs (4%) or did not discuss access at all (33%) despite findings, in part, including access related issues. Remaining studies used the term access in passing or ambiguously (24%), distinguished between attitudes and access in-text (27%), and a minority of studies utilised a theoretical framework which acknowledged accessibility (13%). The focus on access to information (92% of studies) was disproportionately large compared to other domains of accessibility such as availability (11%), affordability (13%), and proximity (16%). Of the seven identified intervention studies, five were centred on information provision.

CONCLUSION

Accessibility is poorly conceptualised within most of the research conducted on childhood immunisation uptake within the UK. This, in part, is because exploring accessibility was not an explicit objective of many of the studies included in the review. It is vital that the accessibility of childhood vaccination services is given greater priority and appropriately defined in empirical research. Otherwise, researchers run the risk of limiting the scope of their findings based on their own conceptual ideas regarding the drivers of poor uptake rather than the lived reality of parents.

Psychometric validation of the Vaccination Attitudes Examination (VAX) scale in German pre-pandemic and mid-pandemic samples

Despite the public health value of immunizations, vaccine hesitancy is a widespread phenomenon and received special attention during the global COVID-19 pandemic. The Vaccination Attitudes Examination (VAX) Scale aims to identify anti-vaccination attitudes for understanding vaccine hesitancy. The present study is the validation of the German version of the VAX scale in pre-/mid-pandemic samples. All individuals completed an online-survey assessing prior and expected future vaccination behaviors, further constructs associated with vaccine hesitancy, as well as anti-vaccination attitudes using the translated VAX scale among others. In a first study, 297 individuals were surveyed before the COVID-19 pandemic. A second study included 260 individuals recruited during the COVID-19 pandemic. For validation, two confirmatory factor analyses have been conducted. Reliability measures (internal consistency, test-retest-correlation) were determined. The four subscales were confirmed by Confirmation Factor Analysis with a very good to excellent fit. The subscales showed good to excellent reliability and convergent validity determinants. Average VAX values significantly distinguished between individuals who had previously received or refused immunization and predicted expected vaccination behavior. The German translation of the VAX scale is effective in identifying anti-vaccination attitudes and can be used for further research on anti-vaccination attitudes and vaccine hesitancy.

Quantitative Measurement of Individual and Contextual Determinants of COVID-19 Vaccination in General Population Samples: A Scoping Review

BACKGROUND

This scoping review aims to map the quantitative literature investigating vaccine-related individual and contextual determinants of COVID-19 vaccination uptake, identify and define constructs assessed, and describe the characteristics of self-report measures.

METHODS

A systematic search of electronic databases was conducted to capture peer-reviewed journal articles published between December 31, 2019, and December 25, 2021. Studies conducted in English and collecting data from general population samples using self-report measures of vaccine-related determinants of COVID-19 vaccination behavior were eligible. Data were analyzed using a descriptive statistics and content analysis, and constructs were mapped onto the COM-B model. The review pre-registration is available on the Open Science Framework ( https://osf.io/82fsz ).

RESULTS

This review identified 157 studies (6153 abstracts and 997 full texts screened) and 425 vaccine-related constructs were retrieved from included studies. Of these, 4% were mapped to capability factors, 85% to motivation, and 11% to opportunity. The most frequently assessed constructs were positive attitudes (19% of constructs), negative attitudes (16%), intention (10%), and beliefs (8%). Only 11% of studies used or adapted pre-existing measures in their surveys. Psychometric properties of self-report measures used were not reported in the majority of studies (60%).

CONCLUSIONS

Findings suggest a predominant focus on perceived individual-level predictors of COVID-19 vaccination with inconsistent measurement, potentially compromising research validity. This research highlights opportunities to explore social/environmental factors, establish unified definitions, and employ validated self-report measures for robust survey-based studies on COVID-19 vaccination determinants.

"Using behavioral insights to inform the COVID-19 vaccine response in Kosovo[1]: Population perceptions and interventions"

Objective

Understand population perceptions in Kosovo[1] regarding COVID-19 vaccination to inform the pandemic response.

Methods

Five rounds of a cross-sectional survey in representative samples of adults during 2020-2021. Analysis includes descriptive statistics, hierarchical cluster analysis, segmentation and logistic regressions.

Results

Self-reported intention to vaccinate increased after the introduction of COVID-19 vaccines in Kosovo.[1] In less than one year, vaccination intentions increased from 36% to 66% of those unvaccinated. Predictors for vaccine intentions included gender, age, trust in health authorities. Segmentation analysis identified population segments that had high vaccine nintentions but low uptake, informing messages and campaign initiatives designed to translate intentions into behavior.

Conclusion

Identifying people's perceptions and behavior is essential to support evidence-based policy making, especially during outbreak response.

Innovation

BI is an innovative focus of research in Kosovo [1] where little BI data had been collected prior, and provided a unique understanding of population views, attitudes and behaviors related to COVID-19. These findings were not only essential for an evidence-based pandemic response but also laid the foundation for future broad application of BI to inform interventions that seek to enable, support and promote health-related behaviurs in Kosovo[1].

Confidence and barriers: Analysis of factors associated with timely routine childhood vaccination in Canada during the COVID-19 pandemic

Routine childhood vaccination is a crucial component of public health in Canada and worldwide. To facilitate catch-up from the global decline in routine vaccination caused by the COVID-19 pandemic, and toward the ongoing pursuit of coverage goals, vaccination programs must understand barriers to vaccine access imposed or exacerbated by the pandemic. We conducted a regionally representative online survey in January 2023 including 2036 Canadian parents with children under the age of 18. We used the COM-B model of behaviour to examine factors influencing vaccination timeliness during the pandemic. We assessed Capability with measures of vaccine understanding and decision difficulty, and Motivation with a measure of vaccine confidence. Opportunity was assessed through parents' self-reported experience with barriers to vaccination. Twenty-four percent of surveyed parents reported having missed or delayed one of their children's scheduled routine vaccinations since the beginning of the pandemic, though most parents reported having either caught up or the intention to catch up soon. In the absence of opportunity barriers, motivation was associated with timely vaccination for children aged 0-4 years (aOR = 1.81, 95 % CI: 1.14-2.84). However, experience with one or more opportunity barriers, particularly clinic closures and difficulties getting an appointment, eliminated this relationship, suggesting perennial and new pandemic-associated barriers are a critical challenge to vaccine coverage goals in Canada.

Hesitant or Confident: A Qualitative Study Examining Latinos' Perceptions of COVID-19 Vaccines in Arizona

This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.

Health service providers' views on barriers and drivers to childhood vaccination of FDMN/Rohingya refugees: a qualitative study in Cox's Bazar, Bangladesh

Background

Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting.

Methods

Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles.

Findings

Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration.

Discussion

For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.

Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population

INTRODUCTION

In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022-2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions.

METHODS

This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan.

RESULTS

Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator.

CONCLUSIONS

A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Multidisciplinary expert group: communication measures to increase vaccine compliance in adults

The WHO categorized vaccine hesitancy as one of the greatest threats to global health worldwide. Vaccination of elderly persons is of increasing relevance, given that they represent a growing segment in the population and considering the burden diseases pose to them. Many factors leading to vaccine hesitancy are related to inadequate communication. In the present report, experts from various academic fields present recommendations to support communication strategies that may help to initiate targeted communication measures to enhance vaccination compliance in adults.

Knowledge and trust of mothers regarding childhood vaccination in Rwanda

INTRODUCTION

Knowledge and trust are some of the contributing factors to vaccine acceptance(VA) and Vaccine hesitancy (VH) is one of the top threats to global health. A significant drop in childhood vaccination has been observed in recent years. One important reason that influences mothers' choice to either postpone or avoid children's vaccinations is knowledge and trust in childhood vaccines. This study aimed to assess mothers' knowledge and trust on vaccination of their children, and to examine the association between vaccination knowledge and selected socio-demographic factors.

METHODS

A cross-sectional survey was conducted from January 2022 to March 2022 to assess the knowledge and trust of mothers regarding childhood vaccination. Data was collected with self-administered questionnaires. Multivariable logistic regression analysis was employed to assess factors associated with childhood vaccine knowledge and trust.

RESULTS

Of the 2,126 Rwandan parents who participated in the study, the proportions with good knowledge of - and good trust in childhood vaccination were 95.5% and 91.4%, respectively. The popular sources of information about childhood vaccination were health care professionals (91.8%) and mass media (28.9%). Multinomial logistic regression analysis showed that good knowledge of - and trust in childhood vaccination were associated with the relationship with child(ren), education, occupation, and monthly income. The Multinomial logistic regression also revealed that the determinants of good knowledge of - and trust in childhood vaccination were; caregiver (p = 4.0 × 10-4, adjusted Odds Ratio (aOR); 1.7, 95%C.I; 1.3 - 2.3), no formal educational status (p = 3.3 × 10-2, aOR; 1.7, 95%C.I; 1.0 - 3.0), the unemployed occupational status (p = 2.4 × 10-2, aOR; 1.2, 95%C.I; 1.0 - 1.4), and persons on more than $401 per month (p = 2.0 × 10-4, aOR; 3.5, 95%C.I; 1.8 - 6.8).

CONCLUSION

The majority of parents in Rwanda had both good knowledge of-and good trust regarding childhood vaccination. Public health strategies to promote vaccination, education programmes as well as improved communication tools between health care professionals/traditional leaders/religious leaders and parents need to be considered to achieve favourable vaccination attitudes and practices for all parents in Rwanda.

Predictors of COVID-19 Vaccine Acceptance: The Role of Trust and the Influence of Social Media

The study discusses the predictors of COVID-19 vaccine acceptance in Romania. We implemented a national survey using an online panel (N = 1006), representative for the online population of Romania aged 18 or higher, conducted on 13-26 October, 2020, by the national pollster QUESTIA. Results show a predictive model of people's willingness to take the COVID-19 vaccine, in which trust in the actors and institutions involved in the management of the crisis is the strongest predictor, followed by the belief in toxic or misleading narratives about vaccines and the COVID-19 pandemic, and media consumption patterns. Education is a moderator of the relationship between trust and the willingness to vaccinate. Implications for professionals in the social work fields, as well as for policy-makers are discussed. Results could be used as a starting point for developing recommendations for evidence-based health communication in the context of the COVID-19 vaccination campaign.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study

Background

Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines.

Methods

This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine.

Conclusion

The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.

Barriers and Motivators toward Childhood COVID-19 Vaccination: A Cross-Sectional Study Conducted among Saudi Population

Background and Objectives: In 2020, one of the most important steps that were made was to give priority to the development of a COVID-19 vaccine to prevent the rising incidence of COVID-19 from continuing to rise. However, globally, there is a variable acceptance of the level of the COVID-19 vaccine. This study aims to explore Saudi parents' willingness to vaccinate their children against COVID-19. Materials and Methods: This was a cross-sectional study; the online questionnaire was used to investigate the views of Saudi parents with children aged under 18 toward the immunization of their children against COVID-19. The data were gathered from 10 May 2022 to 31 October 2022. The data analysis uses SPSS version 20. A p-value of 0.05 or lower was regarded as statistically significant. Results: A total of 978 Saudi parents participated in this study. Most of the respondents were from the age group of 36-45 years with the educational qualification of high school and bachelor's degree. Overall, it was observed that the majority, 98.2% of the respondents, disclosed that they needed more information (p = 0.004) about COVID-19 vaccine safety among children so that they could decide whether to vaccinate their child. About 91.4% of parents mention that vaccination against COVID-19 is not necessary for children (p = 0.001). About 68.3% of respondents agreed that getting vaccinated against COVID-19 could help Saudi Arabia control COVID-19 (p = 0.007, RI = 0.76). In terms of negative attitudes toward COVID-19 vaccination, 71.3% think that there will be severe side effects (p = 0.019, RI = 0.75); 67.7% think that the vaccine's protection will only last for a short time (p = 0.055, RI = 0.72); 80.1% said they were afraid of getting vaccinated because of needle fear (p = 0.045, RI = 0.76), and 41.2% said lack of time was the main barrier to not vaccinating their child. Conclusions: Parents expressed concerns regarding the safety and efficacy of the COVID-19 vaccine, which might be some of the main factors influencing their decision to vaccinate their children. It is the need of the hour to take action to communicate, educate, and intervene with Saudi parents to enhance COVID-19 vaccination compliance rates across the board.

Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal

Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital-Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches.

In the Face of a Pandemic: "I Felt the Same as When the War Started"-A Qualitative Study on COVID-19 Vaccine Acceptance in Bosnia and Herzegovina

Objectives: To conduct qualitative study with different target groups in Bosnia and Herzegovina in order to explore their views on barriers and drivers for COVID-19 vaccination, and to see if and how barriers and drivers vary between urban and rural locations, and different professional roles. Methods: The theoretical framework underpinning the study is the capability-opportunity-motivation (COM-B) behavior change framework, which has been adapted to monitor vaccine related behavior and attitudes. Data was collected from June to September 2022 through moderated discussions in focus groups. The total of 162 participants participated in 16 focus groups. Results: Among the key barriers to successful immunization identified across target groups were insufficient knowledge about vaccines, pandemic fatigue, concerns about the rapid development of the vaccine and its effectiveness, lack of confidence in the healthcare system. Some of the main drivers of vaccination against COVID-19 were confidence in science and expert recommendations. Conclusion: The COVID-19 immunization policy undergoes continuous changes, as do the pandemic prospects; we encourage further research to track the evolution of vaccine related attitudes, inform immunization policy, and create evidence-based interventions.

Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial

BACKGROUND

COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services.

METHODS

This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers.

DISCUSSION

This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023.

Social Representations of Hesitant Brazilians about Vaccination against COVID-19

BACKGROUND

The control of the COVID-19 pandemic has been a great challenge. Understanding the thoughts and beliefs underlying vaccine hesitancy can help in the formulation of public policies. The present study aimed to analyze the social representations of hesitant Brazilians about vaccination against COVID-19.

METHODS

Qualitative research guided by the Theory of Social Representations, carried out through an online survey among Brazilian adults living in Brazil. The data were analyzed using the IRaMuTeQ software.

RESULTS

Of the 173,178 respondents, 10,928 were hesitant and declared reasons for vaccination hesitation. The analysis generated three classes: mistrust of the vaccine and underestimation of the severity of the pandemic; (dis)information and distrust of political involvement; and fear of adverse reactions to COVID-19 vaccines.

CONCLUSIONS

Social knowledge, presented by the representations apprehended in this study, demonstrates difficulty in discerning the reliability of information and a social imagination full of doubts and uncertainties. Understanding the internal dynamics of these groups, with their representations of the world, is important to propose policies and actions that echo and cause changes in the understanding of the role of immunization. It is essential to shed light on the sociological imagination so that gaps filled with false information can be dismantled and confronted with scientific knowledge accessible to the population.

Impact of social media news on COVID-19 vaccine hesitancy and vaccination behavior

In order to take advantage of the power of social media to promote vaccination, this study reveals the mechanisms of positive and negative impacts of social media news on vaccine hesitancy and vaccination behavior. Based on the stimulus-organism-response (S-O-R) framework, we developed a research model to understand the effects of vaccine safety news and risk news from social media (external stimuli) on individuals' psychological organism (i.e., safety perception and risk perception) and consequent behavioral response, vaccine hesitancy and vaccination behavior. The proposed model was tested by partial least square structural equation modeling (PLS-SEM) on a sample gathered in China from September 2021 to November 2021 and from February 2022 to April 2022 (valid responses = 1579). The results found that the relationship between vaccine risk news from social media and risk perception was higher than the relationship between vaccine safety news from social media and safety perception. Individuals are more sensitive to vaccine risk news than safety news on social media. Moreover, both safety perception and risk perception explained the critical psychological mechanisms behind vaccine hesitancy. Interestingly, ego network density mitigated the effect of safety news on safety perception and the effect of risk news on risk perception. The findings contribute to the S-O-R model, the research on social media effects, and the literature on vaccination attitudes and behaviors. This study also informs public health officials about leveraging the power of social media to motivate the public to accept the COVID-19 vaccines.

Modeling the spread dynamics of multiple-variant coronavirus disease under public health interventions: A general framework

The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a single-stranded positive-stranded RNA virus with a high multi-directional mutation rate. Many new variants even have an immune-evading property, which means that some individuals with antibodies against one variant can be reinfected by other variants. As a result, the realistic is still suffering from new waves of COVID-19 by its new variants. How to control the transmission or even eradicate the COVID-19 pandemic remains a critical issue for the whole world. This work presents an epidemiological framework for mimicking the multi-directional mutation process of SARS-CoV-2 and the epidemic spread of COVID-19 under realistic scenarios considering multiple variants. The proposed framework is used to evaluate single and combined public health interventions, which include non-pharmaceutical interventions, pharmaceutical interventions, and vaccine interventions under the existence of multi-directional mutations of SARS-CoV-2. The results suggest that several combined intervention strategies give optimal results and are feasible, requiring only moderate levels of individual interventions. Furthermore, the results indicate that even if the mutation rate of SARS-CoV-2 decreased 100 times, the pandemic would still not be eradicated without appropriate public health interventions.

Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan

Human papillomavirus (HPV) vaccines effectively prevent cervical cancer, most of which results from undetected long-term HPV infection. HPV vaccine introduction is particularly sensitive and complicated given widespread misinformation and vaccination of young girls before their sexual debut. Research has examined HPV vaccine introduction in lower- and middle-income countries (LMICs), but almost no studies attend to HPV vaccine attitudes in central Asian countries. This article describes the results of a qualitative formative research study to develop an HPV vaccine introduction communication plan in Uzbekistan. Data collection and analysis were designed using the Capability, Opportunity, and Motivation for Behaviour change (COM-B) mode for understanding health behaviours. This research was carried out with health workers, parents, grandparents, teachers, and other social influencers in urban, semi-urban, and rural sites. Information was collected using focus group discussions (FGDs) and semi-structured in-depth interviews (IDIs), and data in the form of participants' words, statements, and ideas were thematically analysed to identify COM-B barriers and drivers for each target group's HPV vaccine-related behaviour. Represented through exemplary quotations, findings were used to inform the development of the HPV vaccine introduction communication plan. Capability findings indicated that participants understood cervical cancer was a national health issue, but HPV and HPV vaccine knowledge was limited among non-health professionals, some nurses, and rural health workers. Results on an opportunity for accepting the HPV vaccine showed most participants would do so if they had access to credible information on vaccine safety and evidence. Regarding motivation, all participant groups voiced concern about the potential effects on young girls' future fertility. Echoing global research, the study results highlighted that trust in health workers and the government as health-related information sources and collaboration among schools, municipalities, and polyclinics could support potential vaccine acceptance and uptake. Resource constraints precluded including vaccine target-aged girls in research and additional field sites. Participants represented diverse social and economic backgrounds reflective of the country context, and the communication plan developed using research insights contributed to the Ministry of Health (MoH) of the Republic of Uzbekistan HPV vaccine introduction efforts that saw high first dose uptake.

Factors Affecting Vaccine Attitudes Influenced by the COVID-19 Pandemic

The development of vaccines has significantly contributed to the success of disease prevention. However, there has been a sharp decline in immunization rates since COVID-19 spread globally. Seemingly overnight, the world shut down and most non-essential medical procedures were postponed. Since the COVID-19 vaccine became available, and the world started going back to normal these vaccine rates have not recovered. In this paper, we review the published literature to explore how convenience factors, perceived risk of vaccination, media or anti-vaccination ideals/movements, and healthcare professionals affect an individual’s compliance to be vaccinated to better understand the factors that contribute to the change in overall vaccination rates.

Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden: a qualitative interview study

OBJECTIVES

To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance.

DESIGN

A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis.

SETTING

This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017.

PARTICIPANTS

Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents.

RESULTS

The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers.

CONCLUSION

From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.

COVID-19 phobia, response to the vaccine and the right of urban migrant dwellers in the Ghanaian slums

Purpose

This study investigate urban migrant dwellers’ gender and age differences in response to the specific phobia of COVID-19 and hesitancy toward vaccines in the slum settlements.

Design/methodology/approach

The study anchored on the two-factor model proposed by Mowrer (1939) and used a quantitative design approach with a convenience sampling method for data gathering among 362 urban migrants residing and working in the cities of Ghana. The study used the Mann–Whitney U test and the regression analysis for the analysis.

Findings

The result showed that there is a significant difference between males and females in their understanding of economic phobia, thoughts on social phobia and perception level of vaccine hesitancy. Additionally, there is a significant difference between age groups in their level of thoughts of psychological phobia, economic phobia and thoughts of vaccine hesitancy. Finally, the specific of phobias of COVID-19 are significant predictors of vaccine hesitancy.

Research limitations/implications

This research is slum-specific, which implies that the outcome cannot be generalized to other geographical settings.

Practical implications

The study demonstrates how a pandemic manifests itself to dwellers in slums. The outcome of the study sheds light on how policymakers appreciate the dynamics of the pandemic in a developing country, which may guide future responses to pandemics.

Originality/value

The outcome of the study sheds light on how policymakers appreciate the dynamics of the pandemic in a developing country, which may guide future responses to pandemics.

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa

BACKGROUND

Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA).

METHODS

A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded 'not sure' or 'no' to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of 'vaccine hesitancy' and 'vaccine resistance', respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes.

RESULTS

The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper.

CONCLUSION

We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health.

Design and implementation of tailored intervention to increase vaccine acceptance in a Somali community in Stockholm, Sweden - based on the Tailoring Immunization Programmes approach

Objectives

Sweden has had a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccine (>96%) through the national immunization program (NIP), but coverage rates highlight local pockets of lower vaccination coverage. This project addressed low MMR vaccine acceptance among parents in a Somali community, in Stockholm. The objective of the intervention was to increase vaccine confidence and MMR-vaccine uptake and also to inform practices addressing vaccine acceptance.

Study design

This paper describes the design and implementation of a multi-component intervention based on the Tailoring Immunization Programmes (TIP) approach, developed by the WHO European Regional Office.

Methods

The theoretical underpinning of TIP is the Capability, Opportunity, and Motivation Model (COM-B model) and Behaviour Change Wheel framework (BCW), adapted for vaccination. The COM-model was used to identify barriers and drivers to vaccination and intervention types. The TIP-phases described in this paper are: pre-TIP (planning), three succeeding TIP phases (situational analysis, formative research, intervention design) and the post-TIP phase (implementation).

Results

The situation analysis and formative research revealed that parents feared the MMR vaccine due to autism or that their child would stop talking following vaccination, despite lack of scientific evidence for an association between autism and MMR vaccines. Barriers were linked to their associated COM-B factors and mapped to appropriate intervention types for two target groups: Somali parents and nurses at the Child Health Centres (CHC). Selected intervention types targeting parents were education, persuasion and modelling whereas education and training were selected for CHC nurses. The intervention activities included community engagement for parents, while the activities for nurses focused on improving encounters and dialogue with parents having low vaccine acceptance. Following the intervention design the activities were developed, pilot tested and implemented.

Conclusion

This study confirm that the TIP approach is valuable for guiding a stepwise working process for a thorough understanding of barriers and drivers for MMR vaccination among parents in this Somali community. It facilitated the design of a theory and evidence-informed intervention targeting parents and nurses.

Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than Trust in Trump

STUDY GOAL

This study examines the sources of COVID-19 vaccine hesitancy and refusal in Americans by decomposing different forms of government trust/mistrust including trust in Trump and mistrust in public health institutions.

METHODS

Using linear panel regression models with data from 5,446 US adults (37,761 responses) from the Understanding America Survey, the likelihoods of vaccine hesitancy, uptake, and trust in various information sources were examined.

RESULTS AND CONCLUSION

We find that the likelihoods of hesitancy and having negative perceptions of COVID-19 vaccines were consistently much higher among PHI mistrusters, showing even a stronger hesitancy than Trump trusters. This tendency has persisted over time, resulting in only 49% of PHI mistrusters having been vaccinated in the most recent survey wave. However, a large portion of PHI mistrusters still trusted physicians, family, and friends. These findings suggest that mistrust in PHIs is a salient predictor of vaccine hesitancy and reduced uptake on its own, which is compounded by trust in Trump.

Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea

Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise primary caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with primary caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a primary caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the primary caregiver.

Factors influencing COVID-19 vaccine acceptance and hesitancy among rural community in Bangladesh: A cross-sectional survey based study

Although more than one hundred million beneficiaries were administered COVID-19 vaccine until 20th February, 2022 in Bangladesh; however, proportionally a low turnout has been recorded in rural places and a substantial gap exist among the people living in rural and urban areas concerning the ratio of receiving vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to identify the potential factors influencing vaccine acceptance and hesitancy among the rural community in Bangladesh. A bilingual, self-administered anonymous questionnaire was developed, and data were collected between 10th June 2021 and 14th August 2021 through face-to-face interview. 655 rural people participated in this cross-sectional study, and sampling was done randomly. Descriptive statistics and binary logistic regressions were used to explore and rationalize study objectives. Out of 655 rural participants, 552 (84.3%, 95% CI 81.2─86.8) responded to accept COVID-19 vaccine; however, minor fractions (n = 5, n% = 0.8, 95% CI 0.12-1.4) of rural community had willingness to pay (WTP) for a COVID-19 vaccine. The result of binary regression showed that "safety," "side effects," "effectiveness," and "trust" had highly significant (p <.01) and positive correlation with vaccine acceptance intention. "Rumor" had moderately significant (p <.05) and negative association while "gender" had insignificant correlation with vaccine acceptance intention. Easy and constant access to evidence-based and trustworthy information on vaccination consequences is imperative for resource-less remote people. Health communication regarding safety, side effect, and effectiveness of vaccines were identified as the most important predictor to convert vaccines to vaccinations and for ensuring mass immunization against COVID-19 in Bangladesh.

Vaccination barriers and drivers in Romania: a focused ethnographic study

BACKGROUND

In 2016-18, a large measles outbreak occurred in Romania identified by pockets of sub-optimally vaccinated population groups in the country. The aim of the current study was to gain insight into barriers and drivers from the experience of measles vaccination from the perspectives of caregivers and their providers.

METHODS

Data were collected by non-participant observation of vaccination consultations and individual interviews with health workers and caregivers in eight Romanian clinics with high or low measles vaccination uptake. Romanian stakeholders were involved in all steps of the study. The findings of this study were discussed during a workshop with key stakeholders.

RESULTS

Over 400 h of observation and 161 interviews were conducted. A clear difference was found between clinics with high and low measles vaccination uptake which indicates that being aware of and following recommended practices for both vaccination service delivery and conveying vaccine recommendations to caregivers may have an impact on vaccine uptake. Barriers identified were related to shortcomings in following recommended practices for vaccination consultations by health workers (e.g. correctly assessing contraindications or providing enough information to allow an informed decision). These observations were largely confirmed in interviews with caregivers and revealed significant knowledge gaps.

CONCLUSIONS

The identification of key barriers provided an opportunity to design specific interventions to improve vaccination service delivery (e.g. mobile vaccination clinics, use of an electronic vaccination registry system for scheduling of appointments) and build capacity among health workers (e.g. guidance and supporting materials and training programmes).

Patients' with asplenia and doctors' experiences in implementing preventative measures following a novel educational intervention: a qualitative analysis

OBJECTIVE

To explore patients' with asplenia and general practitioners' (GPs) (1) perceptions of a novel, Health Action Process Approach (HAPA)-based, educational intervention which targets to increase adherence to post-splenectomy sepsis (PSS) prevention measures and (2) their experience in implementing prevention measures following this intervention.

DESIGN

A process evaluation conducted on average 3.5 (for patients) and 3.8 (for GPs) months after the intervention between January 2020 and April 2021 individually by means of semi-structured guideline-based telephone interviews. Data was analysed using qualitative content analysis.

PARTICIPANTS

Volunteer subsample of N=25 patients with asplenia and N=8 GPs who received the intervention. Inclusion criteria were met by prior participation in the intervention (German-speaking, of full age and insured by the cooperating health insurance). Patient selection was done by purposeful selection aiming at maximum variability in terms of adherence to preventative measures prior to intervention participation. Participating GPs are a non-purposeful selected convenience sample. For reasons of data protection, no personal data was collected.

RESULTS

The intervention was positively evaluated and its personal relevancy for patients and for the GPs' professional work became apparent. The intervention promoted risk awareness, intention to action, action planning and subsequently, improved adherence to preventative measures. Helpful factors for implementation among the patients were social support by relatives and GPs. Barriers to adherence identified in both groups can be divided into patient-attributed (eg, comorbidities), doctor-related (eg, lack of knowledge or support) as well as contextual factors (eg, vaccine supply constraints).

CONCLUSIONS

Our findings indicate a patient and GP perceived benefit of the intervention, but still identify prevailing barriers to implementation. In a further step, a quantitative evaluation of the intervention will be conducted and recommendations for integrating the intervention in usual care will be made.

TRIAL REGISTRATION NUMBER

DRKS00015238.

Trends in COVID-19 Vaccine Acceptance in Spain, September 2020‒May 2021

Objectives. To analyze factors associated with COVID-19 vaccine acceptance in Spain, over time. Methods. We used data from a national study that included 5 online surveys carried out every 2 months from September 2020 to May 2021. Each round recruited a sample of 1000 participants aged 18 years or older. We performed a multivariable logistic regression with vaccination acceptance as the dependent variable. We evaluated time trends through the interaction terms of each of the explanatory variables and the time. Results. Vaccination acceptance increased from 43.1% in September 2020 to 84.5% in May 2021. Sex, age, concerns about disease severity, health services overload, and people not wearing a face mask, together with adherence to preventive behavior, health literacy, and confidence in scientists, health care professionals' information, and adequacy of governmental decisions, were variables associated with vaccination acceptance. Conclusions. In a changing situation, vaccine acceptance factors and time trends could help in the design of contextualized public health messages. It is important to strengthen the population's trust in institutions, health care professionals, and scientists to increase vaccination rates, as well as to ensure easy access to accurate information for those who are more reluctant. (Am J Public Health. 2022;112(11):1611-1619. https://doi.org/10.2105/AJPH.2022.307039).

Public acceptance of COVID-19 vaccination among residents of Saudi Arabia: a cross-sectional online study

OBJECTIVES

The acceptance of the COVID-19 vaccine is essential for protecting the world population and stopping the COVID-19 pandemic. This paper aimed to measure public acceptance of the COVID-19 vaccination and the factors that may play an important role in increasing the acceptance of vaccinations in future pandemics.

DESIGN

A cross-sectional, observational study was conducted through a survey designed using the Google Forms platform. In this study, a logistic regression analysis was used to study and detect the variables linked to the acceptance of COVID-19 vaccination. To meet inclusion criteria, participants had to be 18 years or older at the time of collecting the data, reside in Saudi Arabia at the time of the survey, agree to the consent form and be able to complete the survey in Arabic.

SETTING

Randomly selected residents of Saudi Arabia.

NUMBER OF PARTICIPANTS

1658.

RESULTS

In general, the population of Saudi Arabia is supportive of the COVID-19 vaccine (72.0%) and has one of the highest acceptance rates, according to global studies. We found that men (OR 0.73; 95% CI: 0.55 to 0.97) were less likely to hesitate with regard to taking the vaccine, whereas previously infected individuals were more likely to hesitate (OR 1.77; 95% CI: 1.25 to 2.50). Those with a lower monthly income (<3000 Saudi riyal) were more likely to refuse the vaccine (OR 3.54; 95% CI: 1.81 to 6.91), while those living in cities (OR 0.62; 95% CI: 0.39 to 0.99) and the unemployed (OR 0.52; 95% CI: 0.33 to 0.83) were less likely to refuse it. Participants' history of viral infection and trust in the healthcare system were found to be important factors in the public's acceptance of the vaccine.

CONCLUSION

In general, acceptance of the COVID-19 vaccination is high in Saudi Arabia. Several factors have shown a method for predicting those who might reject the vaccine or hesitate to take it; thus, the healthcare system should target those residents throughout the campaign. Based on the conclusions of the current research, the acceptance of vaccinations could be increased.

Medical specialists' attitudes and practices towards childhood vaccination: a qualitative study in Armenia

BACKGROUND

Childhood vaccination rates in Armenia are high. However, anecdotal evidence suggests that some health workers may advise against vaccination. The extent and reasons behind this are unknown. This study used the World Health Organization Tailoring Immunization Programmes approach to investigate medical specialists' vaccination practices.

METHODS

Face-to-face interviews were conducted with 30 medical specialists (paediatricians, immunologists, neonatologists, neurologists, gynaecologists). Interviews explored their vaccination practices (recommending/administering), knowledge, attitudes and confidence. Data were analysed using the Framework approach and COM (Capability, Opportunity, Motivation) factors.

FINDINGS

Medical specialists were routinely consulted by parents about vaccination. They engaged in conversations, even if they did not administer vaccinations and lacked expertise. Vaccination recommendation was "selective", influenced by their own vaccine hesitancy. Doctors administering vaccination used false contraindications to postpone vaccination. Multiple barriers and drivers to positive vaccination practices were evident, with differences between specialists administering/not administering vaccinations. Capability Drivers were knowledge of vaccination, vaccines, and vaccine-preventable diseases; with awareness and use of protocols for adverse events and contraindications (those with a vaccination role). Barriers were a lack of a detailed understanding of vaccination, vaccines, and vaccine-preventable diseases, especially amongst neonatologists and gynaecologists, and for HPV. Poor knowledge of adverse events and mixed knowledge of contraindications was evident, as was low confidence about conversations with parents declining vaccination. Opportunity Drivers were using "official" guidance and professional information and feeling protected by the Government of Armenia should an adverse event occur. Conversely, barriers were a reliance on media/social media without considering credibility, peers not recommending vaccination, increasing parent demands and not feeling protected by the Government. Motivation Drivers were seeing vaccination as their responsibility (those who administer vaccinations); and generally supporting vaccination. Barriers were vaccine hesitancy, some anti-vaccination sentiments amongst neonatologists and gynaecologists and not seeing vaccination as their role (those who do not administer vaccinations).

CONCLUSIONS

Applying a theory-informed approach allowed us to identify critical issues and possible solutions. High vaccination coverage may disguise underlying issues, e.g. false contraindications. We addressed gaps in the literature, with our geographical focus and study of medical specialists advising parents on vaccination, a widely used practice in this sub-region.

COVID-19 vaccine acceptance: knowledge and beliefs

Backgrounds

Vaccine acceptance varies across countries, generations, and the perceived personality of individuals. Investigating the knowledge, beliefs, and acceptability of COVID-19 vaccines among individuals is vital to ensuring adequate health system capacity and procedures and promoting the uptake of the vaccines.

Results

A cross-sectional study was conducted from August 2021 to January 2022 in Saudi Arabia. The study included 281 residents to estimate their acceptance to receive COVID-19 vaccination. Around 70% of the included participants had a moderate to high COVID-19 vaccine acceptance rate during the data collection period. The risk increases to about two folds among undergraduates [OR 1.846 (1.034-3.296), p value = 0.036)] and increases to four folds among non-employed [OR 3.944 (2.310-6.737), p value = 0.001]. About 78% of participants with high and 44% with low COVID-19 vaccine acceptance (p value = 0.001) believed the vaccines were safe and effective. The belief that COVID-19 disease will be controlled within two years increased the risk for low vaccine acceptance by about two folds [OR 1.730 (1.035-2.891), p value = 0.035]. Good knowledge about COVID-19 vaccination significantly affected the acceptance rate (p value = 0.001).

Conclusions

Several factors affect the intention of individuals to receive vaccines. Therefore, building good knowledge and health literacy through educational intervention programs, especially vaccine safety and effectiveness, is important for successful vaccination campaigns among the general population and ensuring control of the COVID-19 pandemic.

Acceptance and hesitancy of parents to vaccinate children against coronavirus disease 2019 in Saudi Arabia

BACKGROUND

Vaccination of masses against coronavirus disease 2019 (COVID-19) is critical to overcome the pandemic and restore normalcy. However, vaccine refusal and hesitancy prevail in many countries. COVID-19 has rapidly spread in Saudi Arabia since 2020. The acceptance rate of COVID-19 vaccines has been investigated in adults aged >18 years in Saudi Arabia. This study aimed to understand the acceptance and hesitancy of parents to vaccinate children aged <12 years against COVID-19 in Saudi Arabia and identify strategies that can encourage their engagement.

METHODS

We used an online cross-sectional survey distributed to parents who lived in all regions of Saudi Arabia to investigate parents' views on the acceptability of a future COVID-19 vaccine for their children aged <12 years. Five hundred parents living in Saudi Arabia completed the survey.

RESULTS

The survey indicated that mothers were more enthusiastic about participating in the study than fathers. The participant aged 37.31 ± 8.52 years. A total of 38.6% of participants refused to vaccinate their children. Additionally, 56% were unsure if the vaccine would cause serious side effects in children. A total of 48.8% of parents believed that the Pfizer vaccine was suitable for children, while 64.5% failed to decide whether to administer vaccines to their children.

CONCLUSION

Vaccine hesitancy remains a major problem worldwide. A lack of scientific evidence on vaccine efficacy, low education level, and reduced level of health education and promotion are the most common factors in parents in Saudi Arabia. However, some participants agreed to receive vaccines only to protect their family members, and due to governmental rules and school mandates. Therefore, vaccine efficacy and safety in children must be clearly communicated to the public. This information would aid in reducing the hesitancy of parents to vaccinate their children against COVID-19.

COVID-19 Vaccine Acceptance and Its Risk Factors in Iranian Health Workers 2021

Background

Ensuring vaccine acceptance in societies is a growing challenge for healthcare systems worldwide. This study aimed to identify factors associated with vaccine acceptance rates.

Methods

This cross-sectional study was conducted as a national web-based survey from February 9^th-13^th, 2021, just before the release of the COVID-19 vaccine in Shiraz, Iran. Independent variables included age, gender, occupation, history of COVID-19 infection, underlying diseases, and source of information. The willingness to be vaccinated was the dependent variable. A logistic regression analysis was performed to determine the relationship between different variables and the willingness to receive the COVID-19 vaccine. The significance level was set at less than 0.05. The data were analyzed using SPSS software version 21.

Results

Of 2,699 healthcare respondents, 70.3% indicated a willingness to receive the COVID-19 vaccine, of whom 49.2% preferred to receive a foreign vaccine and 24.68% desired to receive an Iranian vaccine. The women were more willing to receive the vaccine (67.6%) than the men (78.2%). Based on the results of logistic regression, gender (P<0.001) and job (P=0.005) were the most important associating factors to the willingness to receive the COVID-19 vaccine.

Conclusion

Although the majority of participants were willing to receive the COVID-19 vaccine, 29.6% were not yet ready. Women's healthcare providers were more hesitant to recommend the vaccine. As a result, the findings of this study can help policymakers and decision-makers in the field of health, treatment, and prevention of COVID-19 in raising the level of vaccination awareness among healthcare workers.

HPV-Vaccine Hesitancy in Colombia: A Mixed-Methods Study

In Colombia, the uptake rate of the HPV vaccine dropped from 96.7% after its introduction in 2013 to 9% in 2020. To identify the behavioural components of HPV-vaccine hesitancy in females aged 15 and under and their families, we conducted a convergent mixed-methods study in which 196 parents/caregivers responded to an online questionnaire and 10 focus groups were held with 13 of these parents/caregivers, and 50 age-eligible girls. The study is novel as it is the first to explore the factors influencing HPV-vaccine hesitancy alongside the COVID vaccine within an integrative model of behaviour change, the capability-opportunity-motivation-behaviour (COM-B) model. We found that COVID-19 has had an impact on the awareness of HPV and HPV vaccination. Lack of information about the vaccination programs, concerns about vaccine safety and the relationship between HPV and sexuality could be related to vaccine hesitancy. Trust in medical recommendations and campaigns focused on the idea that vaccination is a way of protecting daughters from cervical cancer could improve HPV vaccine uptake.

Acceptance of Booster COVID-19 Vaccine and Its Association with Components of Vaccination Readiness in the General Population: A Cross-Sectional Survey for Starting Booster Dose in Japan

The Japanese government approved COVID-19 vaccine booster doses in November 2021. However, intentions and readiness for booster vaccines among the general population were unknown. This survey measured the intentions for COVID-19 booster vaccination. Among 6172 participants (53.2% female), 4832 (78.3%) accepted booster doses; 415 (6.7%) hesitated. Vaccination intention was associated with higher age, marital status, having children, underlying diseases, and social norms. To evaluate the readiness for vaccination, the seven component (7C) vaccination readiness scale was employed, comprising “Confidence”, “Complacency”, “Constraints”, “Calculation”, “Collective responsibility”, “Compliance”, and “Conspiracy”. Participants with acceptance showed significantly higher 7C scores (p < 0.001) than those who hesitated or were unsure. Multivariable logistic regression analysis revealed that the “social norms” predictor was the strongest predictor of acceptance (adjusted odds ratio (AOR) 4.02, 95% confidence interval (CI): 3.64−4.45). “Constraints” (AOR: 2.27, 95% CI: 2.11−2.45) and “complacency” (AOR: 2.18, 95% CI: 2.03−2.34) were also strongly associated with acceptance, but “compliance” (AOR: 1.24, 95% CI: 1.18−1.31) and “conspiracy” (AOR: 1.42, 95% CI: 1.33−1.52) were weakly associated. The “7C vaccination readiness scale” is useful for measuring vaccine acceptance in the Japanese population. However, “social norms” might be more suitable than “compliance” and “conspiracy” for measuring vaccine acceptance in Japan.

Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.

Public anxiety through various stages of COVID-19 coping: Evidence from China

As countries underwent the initiation, peak, post-peak, and early vaccination stages of COVID-19, the changing risk perception, coping behaviors and corresponding psychological stress experienced by the public over time was rarely reported. We conducted a national scale panel study using social-psychological data collected from 5,983 questionnaires to investigate the interactions between anxiety level, risk perception and coping behavior during different stages of COVID-19 in China. We found that sustained perceiving worries of being infected, first due to domestic and then global pandemic, contributed to the persistent high proportion of respondents with anxiety disorders which even gradually increased over time (56.1% during initiation to 60.4% during early vaccination). Gender was the strongest predictor of anxiety at all stages, with females having less confidence in COVID-19 control and always suffering from much higher anxiety levels than males even during the post peak stage. Excessive protective behavior and frequency of access to COVID-related news also contributed to public anxiety. Additionally, public risk perception was significantly associated with their willingness to vaccinate. The findings verify the feasibility of taking stage-specific and gender-based risk communication strategies to alleviate the pandemic-related public anxiety and promote vaccination by influencing public risk perception and guiding coping behaviors.

The Effect of Science-Related Populism on Vaccination Attitudes and Decisions

As the COVID-19 pandemic has sadly shown, the decision against vaccination is often linked to political ideologies and populist messages among specific segments of the population: People do not only have concerns about a potential health risk associated with vaccination but seem to have also adopted more populist attitudes towards science. In this study, the relationship between science-related populism and individuals' attitudes towards vaccination was examined, presuming that scientific-related populism also influences individual responses towards different vaccinations. As different types of diseases and their vaccines might be perceived rather distinctively by the public, different vaccinations were considered. The survey is based on responses from 870 people from Germany and Austria. Results indicate that science-related populism influences responses towards some vaccination types, especially for those that receive extensive media coverage such as COVID-19 and measles (MMR). There was no significant impact of science-related populism on individuals' vaccination intentions for other vaccines like seasonal influenza, human papillomavirus, or tick-borne encephalitis. In conclusion, limitations and directions for future research are addressed.

Traumatic Events and Vaccination Decisions: A Systematic Review

Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.

Acceptance of COVID-19 vaccine and determinant factors in the Iranian population: a web-based study

BACKGROUND

Iran had a high rate of death in several COVID 19 waves. Vaccination is a method for prevention and control of the COVID-19 pandemic. Success in controlling the pandemic is not solely dependent on the effectiveness of the vaccines. It is also dependent on the global acceptance and vaccine coverage rate. This study aimed to determine the acceptance rate of COVID-19 vaccination in the Iranian population and the factors affecting it.

METHODS AND MATERIALS

This study was a cross-sectional research on 1564 Iranian people above 18. Study data were collected using a web-based questionnaire and analyzed using linear regression analysis and logistics at a significance level of 0.05 using SPSS.

RESULTS

Approximately 70% of the participants reported acceptance of the vaccines. Ten percent of the people were against and 20% were hesitant to get vaccinated. The results showed that risk perception (P = .003), Knowledge of the disease (P < .001), trust in the health system (P < .001), attitude towards vaccination (P < .001), and vaccination literacy (P < .001) were predictors of vaccine acceptance. People with higher levels of education and mistrust towards the health system had a reduced vaccine acceptance rate.

CONCLUSIONS

The acceptance rate of the COVID-19 vaccine in Iran was higher than in the other countries in the Middle East. Extensive interventions are important to increase the trust in the health system and improve the knowledge of vaccine efficacy and literacy.

What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany

BACKGROUND

Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites.

METHODS

The German-language versions of Instagram, Twitter and YouTube were searched regarding negative attitudes towards COVID-19 vaccination. Data was extracted until a saturation effect could be observed. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the general availability of vaccines against COVID-19 in Germany. We used an interpretive thematic approach to analyze the data and to inductively generate codes, subcategories and categories.

RESULTS

Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination.

CONCLUSIONS

The study emphasizes the relevance of providing trustworthy and quality-assured information on COVID-19 and COVID-19 vaccination to all population groups. In addition, vaccinations should be easily accessible in order to promote the population's willingness to be vaccinated.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review

BACKGROUND AND AIMS

Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count.

METHODS

A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review.

RESULTS

In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States.

CONCLUSIONS

The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.