Addressing vaccine hesitancy and resistance for COVID-19 vaccines

The nurse's role in a patient-centered approach for reducing COVID-19 vaccine hesitancy during pregnancy: An American Academy of Nursing consensus paper

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

Determinants of COVID-19 Vaccine Hesitancy: A Cross-Sectional Study in Three Communities in the United States and Lebanon

The COVID-19 pandemic underscores the significance of vaccine hesitancy in shaping vaccination outcomes. Understanding the factors underpinning COVID-19 vaccination hesitancy is crucial for tailoring effective vaccination strategies. This cross-sectional study, conducted in three communities across the United States and Lebanon, employed surveys to assess respondents' knowledge, attitudes, and perceptions regarding COVID-19 infection and vaccination. Among the 7196 participants, comprising 6775 from the US and 422 from Lebanon, vaccine hesitancy rates were comparable at 12.2% and 12.8%, respectively. Notably, a substantial proportion of respondents harbored misconceptions, such as attributing the potential to alter DNA (86.4%) or track individuals (92.8%) to COVID-19 vaccines and believing in the virus's artificial origins (81%). US participants had more misconceptions about the COVID-19 vaccine, such as altering DNA or causing infertility. Lebanese participants were more likely to question the origins of the virus and the speed of vaccine development. Additionally, US respondents were less worried about infection, while Lebanese respondents were more indecisive but less likely to outright reject the vaccine. Primary determinants of hesitancy included perceptions that the vaccine poses a greater risk than the infection itself (aOR = 8.7 and 9.4, respectively) and negative recommendations from healthcare providers (aOR = 6.5 and 5.4, respectively). Conversely, positive endorsements from healthcare providers were associated with reduced hesitancy (aOR = 0.02 and 0.4, respectively). Targeting healthcare providers to dispel misinformation and elucidate COVID-19 vaccine risks holds promise for enhancing vaccination uptake.

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources.

Vaccine Uptake and Intentions: Insights from a Texas Survey on Factors Influencing COVID-19 Vaccination Decisions

The effectiveness of COVID-19 vaccines depends on widespread vaccine uptake. Employing a telephone-administered weighted survey with 19,502 participants, we examined the determinants of COVID-19 vaccine acceptance among adults in Texas. We used multiple regression analysis with LASSO-selected variables to identify factors associated with COVID-19 vaccine uptake and intentions to receive the vaccine among the unvaccinated. The prevalence of unvaccinated individuals (22%) was higher among those aged 18-39, males, White respondents, English speakers, uninsured individuals, those facing financial challenges, and individuals expressing no concern about contracting the illness. In a fully adjusted regression model, higher odds of being unvaccinated were observed among males (aOR 1.11), the uninsured (aOR 1.38), smokers (aOR 1.56), and those facing financial struggles (aOR 1.62). Conversely, Asians, Blacks, and Hispanics were less likely to be unvaccinated compared to Whites. Among the unvaccinated, factors associated with stronger intent to receive the vaccine included age (over 65 years), Black and Hispanic ethnicity, and perceived risk of infection. Hispanic individuals, the uninsured, those covered by public insurance, and those facing financial challenges were more likely to encounter barriers to vaccine receipt. These findings underscore the importance of devising tailored strategies, emphasizing nuanced approaches that account for demographic, socioeconomic, and attitudinal factors in vaccine distribution and public health interventions.

Understanding Reasons for Vaccination Hesitancy and Implementing Effective Countermeasures: An Online Survey of Individuals Unvaccinated against COVID-19

This online survey of unvaccinated people living in Japan aimed to identify the reasons for declining vaccination and to develop effective countermeasures. We conducted a hierarchical class analysis to classify participants, examine factors influencing their classification, and provide the information they needed about coronavirus disease 2019 (COVID-19) and trusted sources of COVID-19 information for each group. A total of 262 participants were classified into three groups: Group 1 with no specific reason (28 participants, 10.69%); Group 2 with clear concerns about trust in the vaccine (85 participants, 32.44%), and Group 3 with attitudinal barriers, such as distrust of the vaccine and complacency towards COVID-19, and structural barriers, such as vaccination appointments (149 participants, 56.87%). For each group, females tended to be classified in Group 2 more than Group 1 (Odds ratio (OR) [95% confidential intervals (95%CI)] = 1.64 (0.63 to 2.66), p = 0.001) and in Group 3 more than Group 1 (OR [95%CI] = 1.16 (0.19 to 2.12), p = 0.019). The information that the participants wanted to know about COVID-19 was different among each group (Safety: p < 0.001, Efficacy: p < 0.001, Genetic effects: p < 0.001). Those who did not receive the COVID-19 vaccine also had lower influenza vaccination coverage (8.02%). Additionally, 38 participants (14.50%) were subject to social disadvantages because they had not received the COVID-19 vaccine. Countermeasures should be carefully tailored according to the target population, reasons for hesitancy, and specific context. The findings of this study may help develop individualized countermeasures to address vaccine hesitancy.

The second dose of COVID-19 vaccine booster hesitancy among health care workers in China: A multicenter cross-sectional study

BACKGROUND

The COVID-19 outbreak in China exposed health care workers (HCWs) to an increased risk of infection. The acquired immunity rapidly diminishes after the previous COVID-19 vaccination and the second booster vaccination has been recommended in several countries. HCWs are a priority group for vaccination because they are at increased risk of being infected, however, a certain amount of HCWs were hesitant.

METHODS

The survey was conducted among 5805 HCWs in China from January 5 to February 9, 2023. Questionnaire included sociodemographic information, COVID-19-related variables, psychological factors, and the COVID-19 vaccine hesitancy scale. Multiple logistic regression analysis was used to assess the influencing factors of the second dose of COVID-19 vaccine booster hesitancy.

RESULTS

42.2% of HCWs self-reported having the second dose of COVID-19 vaccine booster hesitancy. Occupations, years of working, COVID-19 infection status were associated with less vaccine hesitancy. HCWs who had received 3 doses of COVID-19 vaccine were less likely to be hesitant compared to those had not received. HCWs with PTSD symptoms and anxiety symptoms were more likely to be hesitant. No relation was observed between COVID-19 vaccine booster hesitancy and age, marriage, salary, and perceived an increased risk of COVID-19 infection due to work (all P > 0.05).

CONCLUSIONS

A considerable proportion of HCWs were hesitant to accept the second dose of the COVID-19 booster vaccine. Incorporating vaccine knowledge and new evidence into routine health educations and procedures to raise confidence and reduce complacency may be effective and feasible in promoting the vaccination and implementing future vaccination programs.

Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis

BACKGROUND

Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy.

OBJECTIVE

This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys.

METHODS

We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group.

RESULTS

The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ≥65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake.

CONCLUSIONS

When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age.

COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review

OBJECTIVE

To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries.

DESIGN

A realist review.

DATA SOURCES

Embase, PubMed, Dimensions ai and Google Scholar.

SETTING

High-income countries.

DEFINITIONS

We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021.

RESULTS

We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited.

CONCLUSION

Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.

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.

An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection

We designed the Relative Risk Tool (RRT) to help people assess the relative risks associated with COVID-19 vaccination and infection. In May 2022 (N = 400) and November 2022 (N = 615), U.S. residents participated in a survey that included questions about the risks of vaccination and infection. In both cohorts, we found an association between relative risk perception and vaccine hesitancy. Participants in the May cohort were randomly assigned an intervention: to see information from the RRT or the Centers for Disease Control and Prevention (CDC). After the intervention, participants answered the same questions about risk perception and vaccination intent again. The RRT was more effective than the CDC at changing risk perception and increasing vaccination intent. In November, the survey structure was the same, but the RRT was the only intervention included, and we confirmed that the RRT was effective at changing opinions in this new sample. Importantly, the RRT provided accurate information about the risks of serious adverse outcomes to vaccination and still increased vaccination intent. Our work suggests that the RRT helps people assess relative risk, which can in turn help empower them to make informed decisions and ultimately reduce vaccine hesitancy.

Parents' acceptance attitudes towards the vaccination of children based on M-LSGDM approach in China: a cross-sectional study

OBJECTIVES

Ensuring that children receive timely vaccinations is paramount for preventing infectious diseases, and parental attitude plays a pivotal role in this process. This study addresses this gap in the existing literature by examining parental attitudes towards vaccinating their children.

DESIGN

A cross-sectional study.

METHODS

An online survey including parents' sociodemographic characteristics, risk perception and attitudes towards child vaccination towards COVID-19 was conducted. The modified large-scale group decision-making approach for practicality and binary logistic regression was used to identify the predictors influencing parents' decision-making.

RESULTS

Of the 1292 parents participated, 957 (74.1%) were willing to vaccinate their children, while 335 (25.9%) refused the vaccination. The study indicated that age, parental anxiety regarding child vaccination, concerns about the child's susceptibility to the disease, opinions towards vaccination benefits versus disadvantages, place of residence, average family income and children's health were significant predictors (p<0.05).

CONCLUSIONS

While most parents supported childhood vaccination, some opposed it. Addressing persistent barriers is crucial to ensure widespread vaccination and child well-being.

Characterizing predictors of COVID-19 vaccine refusal in an urban southern California jail population

BACKGROUND

Correctional populations have been disproportionately affected by COVID-19, and many large outbreaks have occurred in jails and prisons. Vaccination is a key strategy to reduce the SARS-CoV-2 transmission in carceral settings. Although implementation can be challenging due to vaccine hesitancy and medical mistrust, correctional settings provide largely equitable healthcare access and present a unique opportunity to identify potential predictors of vaccine hesitancy independent of access issues.

METHODS

We retrospectively analyzed electronic health record data for individuals offered COVID-19 vaccination at the Los Angeles County Jail between January 19, 2021, and January 31, 2023, and used multivariable logistic regression to determine predictors of COVID-19 vaccine refusal.

RESULTS

Of the 21,424 individuals offered COVID-19 vaccination, 2,060 (9.6 %) refused. Refusal was associated with male sex ([aOR] = 2.3, 95 % CI (1.9, 2.8)), age 18-34 ([aOR] = 1.2, 95 % CI (1.1, 1.4), referent group: age 45-54), Black race ([aOR] = 1.2, 95 % CI (1.1, 1.4)), reporting ever being houseless ([aOR] = 1.2, 95 % CI (1.1, 1.3)), and having a history of not receiving influenza vaccination while incarcerated ([aOR] = 2.4, 95 % CI (2.0, 2.8)). When analyzing male and female populations separately, male-specific trends reflected those seen in the overall population, whereas the only significant predictor of vaccine refusal in the female population was not receiving influenza vaccination while in custody ([aOR] = 6.5, 95 % CI (2.4, 17.6)).

CONCLUSION

Identifying predictors of vaccine refusal in correctional populations is an essential first step in the development and implementation of targeted interventions to mitigate vaccine hesitancy.

Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis

Introduction: Evidence exists that individual-level sociodemographic factors contribute to vaccine hesitancy, but it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nationwide survey on COVID-19 vaccine hesitancy with a community-level indicator, i.e., the Distressed Communities Index (DCI). Methods: Attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust were measured using a 48-item, psychometrically valid and reliable survey tool. In this study, 2138 survey participants residing in the United States were divided into quintiles of varying community distress levels based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post hoc analysis with Tukey's test. Results: A significantly higher proportion of participants from the distressed communities had lower trust than their prosperous counterparts (26.6% vs. 37.6%, p < 0.001). On the contrary, participants from the prosperous communities had significantly higher vaccine confidence index scores than those in distressed communities (2.22 ± 1.13 vs. 1.70 ± 1.01, p < 0.001). Conclusions: These findings affirm the importance of developing community-level interventions to promote trust in COVID-19 vaccinations and increase booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions.

COVID-19 Vaccine Perspective From Adolescents' Lens in the US

Introduction The COVID-19 pandemic has presented an unprecedented global health issue. The World Health Organization estimates 773 million confirmed cases and 7 million deaths. Vaccination continues to be the most effective way to prevent COVID-19 and has demonstrated safety and efficacy in all age groups. Though a lot of studies have looked at COVID-19 vaccination acceptance and hesitancy in adults, there is scarce research addressing adolescent vaccination readiness. COVID-19 infection in this age group may result in lost school days, school and community transmission, and loss of productivity for parents. Aim This study aims to determine COVID-19 vaccination rates and factors influencing its acceptance and hesitancy in adolescents in a community setting. Methods A voluntary survey was conducted at a local high school in May 2023. Information was collected about the demographics of adolescents and the educational background of parents/guardians. The survey assessed the COVID vaccine rate, reasons for COVID-19 vaccine acceptance or refusal, number of doses of COVID-19 vaccine and boosters received, prior history of COVID-19 infection, source of information on COVID-19 vaccine, flu vaccine acceptance by the students, and whether they would be willing to take a COVID-19 vaccine booster. Results Four hundred participants, ranging in age from 13 to 19, were surveyed. The vaccination rate in boys was comparable to that in girls. 72% received at least one COVID-19 vaccine, and 66% were considered completely vaccinated. Of those completely vaccinated, 80% had undergone further updated COVID-19 booster vaccinations. Adolescents whose parents/guardians were college graduates had a higher vaccination rate than those whose parents/guardians were not. Caucasians and Asians had a higher vaccination rate compared to African Americans and mixed races. The vaccination rate was not statistically different in adolescents with prior COVID-19 infection versus no prior infection. Flu vaccination was associated with higher COVID-19 vaccination rates. Lack of trust was an important reason for vaccine hesitancy, along with questions about efficacy, concerns about side effects, parent/guardian decisions, and religious reasons. Protecting oneself, family/friends, and community were the major reasons to take the vaccine. Parents/guardians, physicians, peers, television, social media, flyers, and schools were the primary sources that adolescents relied on for information about the COVID-19 vaccination. Conclusion Lower education attainment among parents/guardians, African Americans, and mixed races was associated with lower vaccination rates. Lack of trust in the vaccine, questions about efficacy, and fear of side effects were the most frequently cited reasons for vaccine hesitancy. Parent/guardian influence and religious reasons were other significant reasons for vaccine hesitancy. Flu vaccination was associated with higher COVID-19 vaccination rates. Understanding factors influencing COVID-19 vaccination will allow us to address barriers to COVID-19 vaccination and other vaccinations appropriate for this age group. Educating adolescents in schools, involving local and state health departments to increase awareness about the vaccine, and educating parents and guardians along with the teenagers can help increase the acceptance of the vaccine. These interventions will also positively affect the acceptance of the booster and prepare us for any future pandemics.

Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022

BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

Vaccination against emerging and reemerging infectious diseases in places of detention: a global multistage scoping review

Background

Despite the elevated risks of infection transmission, people in prisons frequently encounter significant barriers in accessing essential healthcare services in many countries. The present scoping review aimed to evaluate the state of availability and model of delivery of vaccination services within correctional facilities across the globe.

Methods

Following the methodological framework for scoping reviews and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews criteria, we conducted a systematic search across four peer-reviewed literature databases (Medline via PubMed, Web of Science, the Cochrane Library, Science Direct, and EBSCO), as well as 14 sources of grey literature. Two researchers meticulously examined the identified papers independently to extract pertinent data published between 2012 and 2022. The quality of the selected publications was assessed using established quality assessment tools.

Results

Of the 11,281 identified papers 52 met the inclusion criteria. With the exception of one, all the included publications presented data from high-income countries, predominantly originating from the United States. Across the world, the most prevalent vaccines available in prison settings were COVID-19 and HBV vaccines, typically distributed in response to health crises such as pandemics, epidemics, and local outbreaks. Vaccine coverage and uptake rates within correctional facilities displayed noteworthy disparities among various countries and regions. Besides, individual and organizational barriers and facilitating factors of vaccination in prison settings emerged and discussed in the text.

Discussion

The lack of vaccination services combined with low rates of vaccination coverage and uptake among people living and working in correctional facilities represents a cause for concern. Prisons are not isolated from the broader community, therefore, efforts to increase vaccine uptake among people who live and work in prisons will yield broader public health benefits.

COVID-19 Vaccine Acceptance and Hesitancy among Nurses in Thailand: Implications, Challenges, and Future Prospects for Attitudes and Vaccine Literacy

Nurses are healthcare workers at high risk of contracting COVID-19 and are prioritized for COVID-19 vaccination. This study aimed to explore COVID-19 vaccine acceptance, vaccine literacy, and attitudes toward COVID-19 vaccines, and determine factors associated with COVID-19 vaccine acceptance among nurses in Thailand. A cross-sectional survey was conducted using online questionnaires between May and June 2021. A total of 510 nurses were recruited during the pandemic's third wave in Thailand. Data were analyzed using descriptive and inferential statistics. Ten percent (n = 51) of the participants were men, all of whom showed COVID-19 vaccine acceptance. Of the 459 female nurses, 94.8% (n = 435) accepted COVID-19 vaccination and 91.3% (n = 419) reported previous influenza vaccination. In multiple logistic regression models, previous influenza vaccination, interactive-critical vaccine literacy, and attitudes toward COVID-19 vaccines were significant predictors of COVID-19 vaccine acceptance among female nurses in Thailand. Those who had previously received influenza vaccination were more likely to accept COVID-19 vaccination. Higher scores for interactive-critical vaccine literacy and positive attitudes toward the COVID-19 vaccine increased the odds of accepting vaccination, while negative attitudes were associated with decreased vaccine acceptance. Vaccine literacy, together with attitudes toward the COVID-19 vaccine, had a strong positive effect on increasing vaccination acceptance and reducing vaccine hesitancy. The results suggest that policymakers should consider both attitudes and vaccine literacy when establishing prospective strategies for promoting vaccine acceptance among nurses beyond the COVID-19 pandemic.

Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach

BACKGROUND

In the absence of an effective treatment method or vaccine, the outbreak of the COVID-19 pandemic elicited a wide range of unprecedented restriction policies aimed at mitigating and suppressing the spread of the SARS-CoV-2 virus. These policies and their Stringency Index (SI) of more than 160 countries were systematically recorded in the Oxford COVID-19 Government Response Tracker (OxCGRT) data set. The SI is a summary measure of the overall strictness of these policies. However, the OxCGRT SI may not fully reflect the stringency levels of the restriction policies implemented in Korea. Korea implemented 33 COVID-19 restriction policies targeting 4 areas: public facilities, public events, social gatherings, and religious gatherings.

OBJECTIVE

This study aims to develop new Korea Stringency Indices (KSIs) that reflect the stringency levels of Korea's restriction policies better and to determine which government-implemented policies were most effective in managing the COVID-19 pandemic in Korea.

METHODS

The random forest method was used to calculate the new KSIs using feature importance values and determine their effectiveness in managing daily COVID-19 confirmed cases. Five analysis periods were considered, including November 01, 2020, to January 20, 2021 (Period 1), January 20, 2021, to June 27, 2021 (Period 2), November 01, 2020, to June 27, 2021 (Period 3), June 27, 2021, to November 01, 2021 (Period 4), and November 01, 2021, to April 24, 2022 (Period 5).

RESULTS

Among the KSIs, public facilities in period 4, public events in period 2, religious gatherings in periods 1 and 3, and social gatherings in period 5 had the highest importance. Among the public facilities, policies associated with operation hour restrictions in cinemas, restaurants, PC rooms, indoor sports facilities, karaoke, coffee shops, night entertainment facilities, and baths or saunas had the highest importance across all analysis periods. Strong positive correlations were observed between daily confirmed cases and public facilities, religious gatherings, and public events in period 1 of the pandemic. From then, weaker and negative correlations were observed in the remaining analysis periods. The comparison with the OxCGRT SI showed that the SI had a relatively lower feature importance and correlation with daily confirmed cases than the proposed KSIs, making KSIs more effective than SI.

CONCLUSIONS

Restriction policies targeting public facilities were the most effective among the policies analyzed. In addition, different periods call for the enforcement of different policies given their effectiveness varies during the pandemic.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Awareness of and attitude toward COVID-19 vaccination among individuals with COPD and the strategies to overcome vaccine hesitation: A mini review

Coronavirus Disease 2019 (COVID-19) vaccines have a protective effect on individuals with chronic obstructive pulmonary disease (COPD), preventing them from developing severe illnesses and reducing the risk of hospitalization and mortality. However, the coverage rate of COVID-19 vaccination among this population is not satisfactory, which is associated with their lack of awareness of and negative attitudes toward COVID-19 vaccination, that is, vaccine hesitancy. We reviewed recent literatures on the vaccination status of COPD patients and vaccine hesitancy, described the factors related to vaccine hesitancy among COPD patients, and proposed strategies to improve the vaccine coverage, such as providing accurate and consistent vaccine information to the public, patient health education program, improving self-management capabilities, easy access to vaccination service, etc., which can hopefully help to improve patients' ability to cope with SARS-CoV-2 infection and reduce the COVID-19 related mortality.

Development of an eLearning intervention for enhancing health professionals' skills for addressing COVID-19 vaccine hesitancy

Like many countries, Greece has faced resistance to coronavirus disease 2019 (COVID-19) vaccination among residents for both the initial and booster doses. Supporting healthcare professionals with delivering brief advice on COVID-19 vaccination may assist with reaching national vaccination targets. We sought to rapidly develop, pilot test, and deploy an eLearning intervention on skills training on effective techniques for addressing COVID-19 vaccine hesitancy for primary health and social care professionals in Greece. A five-part, 1.5-h eLearning was produced in Greek which featured two behavior change techniques, Very Brief Advice (VBA) and Motivational Interviewing (MI) adapted for use in addressing COVID-19 vaccine hesitancy. Six-film-based case studies modeling the use of VBA and MI in the context of challenging scenarios typically seen in Greek health and social settings were produced for the eLearning. The CME was pilot tested using a pre-post design in a small convenience sample (n = 17) of health care professionals. Pilot study results found the training provided new knowledge (80%), improved provider skills (80%), and was useful to provider's clinical practice (90%). There was a mixed effect in provider capability, motivation, and opportunity. Ninety percent of providers strongly agreed or agreed that they planned to use the information and skills provided by the training in their clinical practice. This project has resulted in new training assets for use by health and social professional tailored to the nationally context in Greece including supporting uptake of booster doses of the COVID-19 vaccine.

Willingness to vaccinate among adults, and factors associated with vaccine acceptance of COVID-19 vaccines in a nationwide study in Poland between March 2021 and April 2022

Introduction

Despite the availability, safety and effectiveness of COVID-19 vaccines, Poland remains one of the six countries of the European Union with the lowest cumulative uptake of the vaccine's primary course in the general population. This study examined willingness to vaccinate and the associated factors in samples of unvaccinated and vaccinated adults between March 2021 and April 2022.

Methods

Data were collected using OBSER-CO, a nationwide, repeated cross-sectional study, conducted at four different time points (rounds). Data on willingness to vaccinate among the unvaccinated (at all rounds) and willingness to receive another dose in the vaccinated (at 2 rounds-after booster introduction), reasons for reluctance, sociodemographic, health, and behavioral factors were collected using a uniform questionnaire via computer-assisted telephone interviewing. In each round, more than 20,000 respondents were interviewed. To assess associations between factors and willingness to vaccinate, separate multivariable logistic regression models were fitted for each factor at each round and adjusted for confounders.

Results

Between rounds 1 and 4 (March 2021-April 2022), in the unvaccinated, willingness to vaccinate declined from 73 to 12%, whereas in the vaccinated, willingness to receive another dose declined from 90 to 53%. The highest magnitude of decline between subsequent rounds occurred during the Omicron wave. Overall, concerns about side effects, effectiveness, and vaccine adverse effects were common but decreased over time. Age, gender, employment, place of residence, COVID-19 diagnosis or exposure, hospitalization, and participation in social activities were among the factors associated with willingness. However, associations changed over rounds highlighting the influence of different pandemic waves and variants.

Conclusion

We observed a declining and multifactorial willingness to vaccinate in Poland, with vaccine attitudes dynamically changing across subsequent rounds. To address vaccine concerns, sustained health communication about COVID-19 vaccines is essential, especially after the emergence of new variants.

Assessing associations and predictors of COVID-19 vaccine uptake among college students in a university setting

Objectives: This study assessed the uptake of the COVID-19 vaccine and factors related to vaccination coverage among college students in a university setting. Methods: A cross-sectional study design included undergraduate and graduate students in a university community as study participants. Survey questions assessed the uptake of the COVID-19 vaccine and various predictor variables related to vaccination decision-making. Data analysis included descriptive statistics, correlation statistics, and binary logistic regression. Results: Of the 385 participants, most were undergraduate students. Participants who received the influenza vaccine in the past flu season were more likely to receive the COVID-19 vaccine. Participants with perceived susceptibility to COVID-19 were five times more likely to receive the COVID-19 vaccine. Conclusions: Influenza vaccination coverage and perceived susceptibility were associated with the uptake of the COVID-19 vaccine. Study findings may serve to inform behavior change interventions and educational programs for students in university communities.

A risk science perspective on vaccines

Vaccines can be seen as one of the greatest successes in modern medicine. Good examples are the vaccines against smallpox, polio, and measles. Unfortunately, vaccines can have side effects, but the risks are considered by the health authorities and experts to be small compared to their benefits. Nevertheless, there are many who are skeptical of vaccination, something which has been very clearly demonstrated in relation to the COVID-19 disease. Risk is the key concept when evaluating a vaccine, in relation to both its ability to protect against the disease and its side effects. However, risk is a challenging concept to measure, which makes communication about vaccines' performance and side effects difficult. The present article aims at providing new insights into vaccine risks-the understanding, perception, communication, and handling of them-by adopting what is here referred to as a contemporary risk science perspective. This perspective clarifies the relationships between the risk concept and terms like uncertainty, knowledge, and probability. The skepticism toward vaccines is multifaceted, and influenced by concerns that extend beyond the effectiveness and safety of the vaccines. However, by clarifying the relationships between key concepts of risk, particularly how uncertainty affects risk and its characterization, we can improve our understanding of this issue.

Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.

Communicating effectively with patients about vaccination: A systematic review of randomized controlled trials

Background

Good communication between healthcare professionals and their patients is essential to enlighten the benefits and risks of vaccination. Despite the availability of effective vaccines, reluctance prevails, sometimes fuelled by sub-optimal communication leading to a lack of trust. An evaluation of the effectiveness of a communication strategy for which healthcare professionals are trained has yet to be carried out.

Objective

Systematic review of studies with a randomized controlled trial (RCT) to define and evaluate the impact of healthcare professionals' communication on patients' vaccine adherence.

Methods

We performed a structured search on Medline, Embase, CENTRAL, PsycINFO and CINAHL. The studies selected include those involving healthcare professionals authorized to administer vaccines according to Canadian guidelines. Primary outcomes include vaccination rate or vaccine hesitancy rate.

Results

Nine articles were included. Five studies (n=5) reported intervention effectiveness according to vaccine adherence. The results are largely represented by parental vaccine hesitancy for human papillomavirus (HPV) or childhood vaccination, while three studies (n=3) target the general population. The risk of bias relative to the studies is either low (n=7) or of some concern (n=2).

Conclusion

The effectiveness of communication varies according to the studies and knowledge acquired through training. Future studies will need to examine communication with healthcare professionals in order to establish a consensus on optimal and appropriate training.

Portrait of French-speaking minorities with respect to vaccination against COVID-19

Background

The coronavirus disease 2019 (COVID-19) vaccination campaign highlighted the requirement to better understand the needs of different populations. French-speaking minorities (FSMs) have greater difficulty accessing quality care in French, and this problem was exacerbated during the COVID-19 pandemic.

Objective

The aim of this survey was to develop a descriptive portrait of the health needs of FSMs in relation to the COVID-19 vaccination campaign by describing their vaccination status, attitudes and beliefs compared with English-speaking majorities.

Methods

A survey was conducted among eligible participants using convenience sampling. Data measurement includes a descriptive statistical comparison using analysis of the variance, univariate logistic regressions and a two-proportions z-test.

Results

Of the 1,505 respondents (554 FSMs vs. 951 English speakers), the FSMs have an average age of 51.4 years and 89.2% are Canadian citizens. Vaccination of children was preponderant among English speakers (74.2% vs. 86.3%), including against COVID-19 (58.6% vs. 73.9%). A higher proportion of FSMs had gotten vaccinated in order to obtain a vaccine passport (39% vs. 29.3%). Among the unvaccinated, FSMs were more likely to question the efficacy of vaccines (60% vs. 36.4%). Canadian citizen FSMs with higher education could be divided in relation to the vaccine regimen.

Conclusion

This survey revealed differences between FSMs and the English-speaking majority in their perceptions of vaccine efficacy, particularly vaccination of children, and a polarization of attitudes/beliefs among FSMs according to certain sociodemographic factors.

Perceived Role, Identity and Experiences of Pharmacists and the Potential Impact on COVID-19 Vaccine Uptake per Louisiana Region: A Prospective Cohort Study

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.

Attitude and Acceptance towards COVID-19 Booster Doses among Literacy Advantaged Population in Pakistan: A Cross-Sectional Study

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected billions of lives and is expected to impose a significant burden on the economy worldwide. Vaccination is the only way to prevent the infection. However, convincing people to get themselves vaccinated is challenging in developing countries such as Pakistan. Therefore, a cross-sectional questionnaire-based study was conducted (n = 982 participants) all over Pakistan to evaluate the perception, knowledge, attitude, and acceptance of the general public towards the SARS-CoV-2 vaccine, in general, and a booster dose of SARS-CoV-2, in particular. The highest number of participants were from the province of Punjab (84.5%), followed by Islamabad (3.8%), Sindh (3.7%), Khyber Pakhtunkhwa (2.7%), Baluchistan (2.6%), Gilgit Baltistan (1.4%), and Azad Jammu and Kashmir (1.4%). A total of 915 participants were vaccinated against COVID-19, out of which 62.2% received one booster dose, followed by double booster doses (25.5%) and single vaccine shots (12.3%). The highest number of vaccinated participants were from Punjab (85.8%), followed by Islamabad (3.9%), Sindh (2.8%); Khyber Pakhtunkhwa (2.6%); Baluchistan (2.3%); Gilgit-Baltistan (1.3%); and Azad, Jammu, and Kashmir (1.2%). Among the vaccinated individuals, 71.4% were unemployed, 27.4% were employed (653), and 1.2% were retired from service. However, no significant association was observed among genders and educational levels in regard to acceptance of the booster vaccine. The outcomes of the study revealed that the increased acceptance of booster doses of the SARS-CoV-2 vaccines among the public was associated with the intent of personal and family protection. Moreover, individuals with low socioeconomic status and pregnant females showed the least acceptance towards the vaccine inoculation. The study also revealed a decline trend of accepting SARS-CoV-2 vaccine among children.

The Moderating Effect of Vaccine Hesitancy on the Relationship between the COVID-19 Vaccine Coverage Index and Vaccine Coverage

To examine COVID-19 vaccination barriers in the US, this study drew on publicly available county-level data (n = 3130) to investigate the impact of vaccine hesitancy on the relationship between county-level social/structural barriers and vaccine coverage. A hierarchical regression was performed to establish the relationship between the COVID-19 Vaccine Coverage Index (CVAC) and vaccine coverage, assess the moderating effect of vaccine hesitancy on this relationship, and explore the influence of ethno-racial composition on vaccine coverage. A significant, negative relationship (r² = 0.11, f² = 0.12) between CVAC and vaccine coverage by county was established (step 1). When vaccine hesitancy was introduced as a moderator (step 2), the model significantly explained additional variance in vaccine coverage (r² = 0.21, f² = 0.27). Simple slopes analysis indicated a significant interaction effect, whereby the CVAC-vaccine coverage relationship was stronger in low hesitancy counties as compared with high hesitancy counties. Counties with low social/structural barriers (CVAC) but high hesitancy were projected to have 14% lower vaccine coverage. When county-level ethno-racial composition was introduced (step 3), higher proportions of white residents in a county predicted decreased vaccination rates (p < 0.05). Findings indicate that CVAC should be paired with vaccine hesitancy measures to better predict vaccine uptake. Moreover, counties with higher proportions of white residents led to decreases in vaccine uptake, suggesting that future intervention strategies should also target whites to reach herd immunity. We conclude that public health leaders and practitioners should address both social/structural and psychological barriers to vaccination to maximize vaccine coverage, with a particular focus on vaccine hesitancy in communities with minimal social/structural barriers.

How Scientists View Vaccine Hesitancy

This paper examines possible causes, consequences, and potential solutions for addressing vaccine hesitancy in the United States, focusing on the perspectives of academic scientists. By examining the experiences of scientists, who are arguably a critical community in US society, we gain deeper insights into how they understand the complexities of vaccine hesitancy and whether their insights and opinions converge with or diverge from the current literature. We present findings from a national survey of a representative sample of academic scientists from the fields of biology and public health regarding vaccine hesitancy and related topics. Empirical analysis using descriptive, bivariate, and multivariate analyses covers multiple topics, including vaccine controversy, trust in science, causes of vaccine hesitancy, preferred policy and regulatory approaches, risk perceptions, and scientists' ethics and perceived communication roles. The results highlight a diversity of opinions within the scientific community regarding how to improve science-society communication in regard to vaccines, including the need to be transparent and candid to the public about the risk of vaccines and their research.

The Prevalence of COVID-19 Vaccine Hesitancy Among the Black Asian Ethnic Minority in New South Wales, Australia

INTRODUCTION

Vaccination provides a cost-effective approach to controlling the COVID-19 pandemic. The success of vaccination depends on global preparedness and acceptance of the new vaccines, and this is threatened by vaccine hesitancy worldwide. This study aimed to measure the prevalence of COVID-19 vaccine hesitancy, attitudes, and contributing factors in the Black Asian Ethnic Minority (BAME) of New South Wales (NSW), Australia.  Aim: This study aimed to measure the prevalence of COVID-19 vaccine hesitancy and identify contributing factors leading to vaccine hesitancy in the Black Asian and Ethnic Minority (BAME) in NSW.

METHOD

A cross-sectional study was conducted among the BAME community in NSW; over 12 weeks, from January 3^rd, 2022, to March 28^th, 2022. The study used the pre-existing previously known 5Cs model (confidence, constraints, complacency, calculation, and collective responsibility) to assess reasons for hesitancy. The questionnaire was distributed in English using social media platforms: Facebook and WhatsApp.

RESULTS

The study received 101 respondents over 18 years from all states in Australia from BAME communities, males and females, with different educational levels, employment sectors, marital statuses, co-existing chronic medical conditions, previous COVID-19 infection status, and COVID-19 vaccine received. Of these, 56 respondents were from NSW. Our findings revealed a high prevalence of COVID-19 vaccine hesitancy among the BAME community in NSW, with 72.8% of respondents demonstrating hesitancy/reluctance due to various attitudes identified by the 5Cs model. Despite this high hesitancy, 98.2% of the participants had received at least one to three vaccine doses.

CONCLUSION

 Even in populations with high vaccine uptake, it is still essential to address vaccine hesitancy and provide ongoing education about the importance of vaccination, particularly as new variants of COVID-19 continue to emerge and the need for booster shots may arise. This can help ensure continued protection against the virus and prevent future outbreaks.

Relationships Between Social Vulnerability and Coronavirus Disease 2019 Vaccination Coverage and Vaccine Effectiveness

BACKGROUND

Coronavirus disease 2019 (COVID-19) vaccination coverage remains lower in communities with higher social vulnerability. Factors such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure risk and access to healthcare are often correlated with social vulnerability and may therefore contribute to a relationship between vulnerability and observed vaccine effectiveness (VE). Understanding whether these factors impact VE could contribute to our understanding of real-world VE.

METHODS

We used electronic health record data from 7 health systems to assess vaccination coverage among patients with medically attended COVID-19-like illness. We then used a test-negative design to assess VE for 2- and 3-dose messenger RNA (mRNA) adult (≥18 years) vaccine recipients across Social Vulnerability Index (SVI) quartiles. SVI rankings were determined by geocoding patient addresses to census tracts; rankings were grouped into quartiles for analysis.

RESULTS

In July 2021, primary series vaccination coverage was higher in the least vulnerable quartile than in the most vulnerable quartile (56% vs 36%, respectively). In February 2022, booster dose coverage among persons who had completed a primary series was higher in the least vulnerable quartile than in the most vulnerable quartile (43% vs 30%). VE among 2-dose and 3-dose recipients during the Delta and Omicron BA.1 periods of predominance was similar across SVI quartiles.

CONCLUSIONS

COVID-19 vaccination coverage varied substantially by SVI. Differences in VE estimates by SVI were minimal across groups after adjusting for baseline patient factors. However, lower vaccination coverage among more socially vulnerable groups means that the burden of illness is still disproportionately borne by the most socially vulnerable populations.

COVID-19 Vaccines Status, Acceptance and Hesitancy among Maintenance Hemodialysis Patients: A Cross-Sectional Study and the Implications for Pakistan and Beyond

COVID-19 vaccine hesitancy continues to be a widespread problem in Pakistan due to various conspiracy beliefs, myths and misconceptions. Since the hemodialysis population is at a higher risk of contracting infections, we sought to investigate the current COVID-19 immunization status and reasons for any vaccine hesitancy among these patients in Pakistan. This cross-sectional study was conducted among maintenance hemodialysis patients at six hospitals in the Punjab Province of Pakistan. Data were collected anonymously using a questionnaire. A total of 399 hemodialysis patients took part in the survey, the majority of them were male (56%) and aged 45-64 years. A calculated 62.4% of the patients reported receiving at least one dose of the COVID-19 vaccine. Of those vaccinated (249), 73.5% had received two doses and 16.9% had received a booster dose. The most common reasons for vaccination were "being aware they were at high risk" (89.6%), "fear of getting infected" (89.2%) and "willingness to fight against COVID-19-pandemic" (83.9%). Of the 150 patients who had not yet been vaccinated, only 10 showed a willingness to take the COVID-19 vaccine. The major reasons for refusal included "COVID-19 is not a real problem" (75%), the "corona vaccine is a conspiracy (72.1%)" and "I don't need the vaccine" (60.7%). Our study revealed that only 62% patients receiving hemodialysis were partially or completely vaccinated against COVID-19. Consequently, there is a need to initiate aggressive approaches to educate this high-risk population in order to address their concerns with vaccine safety and efficacy as well as correct current myths and misconceptions to improve the COVID-19 immunization status in this population.

Do psychological distress and digital sports influence the willingness to take the vaccine and precautionary saving? Empirical evidence from Shanghai

Aim

The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings.

Subject and methods

We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16-60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest.

Results

Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save.

Conclusions

This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications.

Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP)

Dengue represents a major public health concern. With effective vaccines in development, it is important to identify motivational factors to maximize dengue vaccine uptake. A cross-sectional, quantitative, electronic survey was administered to a nationally representative adult population (n = 3800) in Argentina, Brazil, Colombia, Mexico, Indonesia, Malaysia, and Singapore. Willingness to vaccinate against dengue, and Knowledge, Attitudes, and Practices (KAP) toward dengue, vector control, prevention, and vaccination were determined. The Capability, Opportunity, Motivation for Behavior change (COM-B) framework was used to identify factors correlated with dengue vaccine(s) uptake. KAP scores (standardized, 0–100% scale) resulted in a low global score for Knowledge (48%) and Practice (44%), and a moderate score for Attitude (66%); scores were comparable across countries. Of all respondents, 53% had a high willingness (Score: 8–10/10) to vaccinate against dengue, which was higher (59%) in Latin America (Argentina, Brazil, Colombia, Mexico) than in Asia Pacific (40%) (Indonesia, Malaysia, Singapore). Key factors significantly (p < 0.05) associated with increased willingness to vaccinate included accessibility to the public (subsidies and incentives) and trust in the healthcare system and government. A common approach to dengue prevention across endemic countries––with some country-specific customization, including education, vaccination, and vector control (multi-pronged)––may reduce dengue burden and improve outcomes.

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.

Global pattern and determinants of coronavirus disease 2019 (COVID-19) vaccine coverage and progression: a global ecological study

Background

Understanding and minimizing existing global coronavirus disease 2019 (COVID-19) vaccination disparities is critical to global population health and eliminating health inequities. The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies.

Methods

COVID-19 vaccination coverage data from 206 countries used in the study were derived from "Our World in Data" website. After obtaining the vaccination coverage indicators, we fitted the progression indicators for vaccination. Correlation and multiple linear regression analysis were used to examine the effects of GDP per capita, Gini index, education, and their interactions on the coverage and progression of the COVID-19 vaccination.

Results

The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses for total number of doses, from less than 15% to more than 75% for proportion of people vaccinated, from less than 15% to more than 60% for proportion of people fully vaccinated. Similarly, the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses, from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated, and from less than 0.1 to more than 0.4 for progression of proportion of people fully vaccinated. GDP per capita and education were positively associated with the coverage and progression, while Gini index was negatively associated with the coverage and progression. Negative interaction between GDP per capita and education was also observed for coverage (β = -0.012 to -0.011, P < 0.05) and progression (β = -0.012 to -0.011, P < 0.05).

Conclusions

Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination. Economy and education are two important factors contributing to the disparities. Different countries may adopt varied strategies to promote the national distribution and vaccination of COVID-19 vaccines.

A Bibliometric Visualization Analysis on Vaccine Development of Coronavirus Disease 2019 (COVID-19)

Coronavirus disease 2019 (COVID-19), beginning in December 2019, has spread worldwide, leading to the death of millions. Owing to the absence of definitive treatment, vaccination against COVID-19 emerged as an effective strategy against the spread of the pandemic. Acceptance of the COVID-19 vaccine has advanced considerably, and vaccine-related research has significantly increased over the past three years. This study aimed to evaluate the content and external characteristics of COVID-19 vaccine-related literature for tracking research trends related to the global COVID-19 vaccine with the means of bibliometrics and visualization maps. A total of 18,285 records in 3499 journals were retrieved in the Web of Science Core Collection database and included in the final analysis. China was the first to focus on COVID-19 vaccine research, while European and American countries started late but developed rapidly. The USA and the UK are the top contributors to COVID-19 vaccine development, with the largest number of publications. The University of Washington and Harvard Medical School were the leading institutions, while Krammer, F. from Icahn School of Medicine at Mount Sinai was the author most active and influential to the topic. The New England Journal of Medicine had the highest number of citations and the highest TLS, and was the most cited and influential journal in the field of COVID-19 vaccine research. COVID-19 vaccine research topics and hotspots focused on populations' attitudes towards vaccination, immunity-related information analysis of spike proteins, the effectiveness and side effects of the COVID-19 vaccine, and the public management of epidemic transmission. The findings of this study provide the global status, research hotspots and potential trends in the field of COVID-19 vaccine research, which will assist researchers in mastering the knowledge structure, and evaluating and guiding future developmental directions of COVID-19 vaccine.

Satisfaction with COVID-19 Vaccines in Health Care Workers and the General Population: A Cross-Sectional Study in Urban Bangkok, Thailand

Background: COVID-19 vaccination hesitancy is a global issue. Many people are concerned about experiencing side effects from the vaccine. This study evaluated satisfaction with the COVID-19 vaccine in the general population (GP) and healthcare workers (HCWs) in Bangkok, Thailand. Methods: A cross-sectional online survey was distributed from September-December 2021. Independent sample t-tests were used to compare GP and HCW participants’ total vaccine satisfaction scores as well as their satisfaction with varying vaccine types. Multiple linear regression was used to identify predictors of satisfaction scores among GP and HCWs. Results: A total of 780 valid questionnaire responses were obtained. The majority of GP participants (n = 390) had received their first (93.3%) and second (88.5%) vaccination shots by viral vector vaccine; however, 90% had not received a third dose (booster). In contrast, the majority of HCW participants (n = 390) had received their first (92.8%) and second (82.8%) vaccination doses by the inactivated vaccine, and 83% had received a third vaccine dose. HCWs had significantly higher total satisfaction scores than GP participants (p = 0.034), and they were also significantly more satisfied with the mRNA vaccine as a third dose (p = 0.001). Multiple linear regression models found less association with vaccine satisfaction among GP participants who had not isolated following exposure to COVID-19 and those who have never been at risk of infection (ᵦ −0.159; 95% CI −12.867, −1.877; p = 0.009). Among HCWs, being married (ᵦ 0.157; 95% CI 0.794, 3.278; p = 0.001) or divorced (ᵦ 0.198; 95% CI 3.303, 9.596; p < 0.01) was more closely associated with vaccine satisfaction than being single. Conclusion: HCWs were more satisfied with the type and efficacy of inactivated, viral vector, and mRNA vaccines than GP participants, and the former were also more satisfied with the cost of vaccine boosters. Our results indicate that satisfaction with the COVID-19 vaccine is based on academic knowledge sharing and the government’s promotion efforts. Future research will explore strategies to raise awareness about the importance of vaccination.

Identifying the determinants of non-injection of covid-19 vaccine: A qualitative study in Urmia, Iran

Objective

Extensive vaccination coverage is one of the most effective ways to control COVID-19 vaccine, but the tendency to inject the vaccine is always hampered and there are various determinants of non-injection. Hence, the present study was done with the aim of identifying the determinants of non-injection of COVID-19 vaccine with a qualitative approach in the city of Urmia in Iran.

Methods

The present study was conducted with a qualitative approach and conventional content analysis method among 36 people who refused to be vaccinated. Access to participants and data collection was done in person (28 interviews) and online (8 interviews) through targeted sampling and snowball method and semi-structured interviews. Data management was performed using MAXQDA-2018 software and its analysis was performed by Graneheim and Lundman method. Also, Guba and Lincoln criteria were observed to improve the quality of results.

Results

After analyzing the data, 3 main categories and 11 subcategories were obtained including (1) Individual factors (fear of short-term side effects of vaccine, personality traits, distrust of vaccines and pharmaceutical companies), (2) Socio-cultural factors (conspiracy theory, social learning, misconceptions about COVID-19, fatalism), legal and managerial factors (incomplete information, difficult and irregular access to vaccination centers, lack of restrictions and compulsion to be vaccinated, lack of incentives to be vaccinated).

Conclusion

The results showed that various determinants were involved in the non-injection of COVID-19 vaccine. Therefore, efforts to increase vaccination coverage require comprehensive measures at different levels and cross-sectoral cooperation between governmental and non-governmental institutions and organizations.

SARS-CoV-2 the ASIA virus (autoimmune/autoinflammatory syndrome induced by adjuvants), the risk of infertility and vaccine hesitancy

INTRODUCTION

COVID-19 has had a calamitous impact on the global community. The current death toll far exceeds 6 million and large numbers of patients are experiencing long-term medical and psychiatric morbidity from the infection. The immunopathology of severe COVID-19 is now better understood. In severely affected patients, there is a chaotic, destructive immune response triggered by SARS-CoV-2, where autoimmunity features prominently.

AREAS COVERED

COVID-19 vaccines ensure a coordinated, balanced immune response to future SARS-CoV-2 infection. The rapid global deployment of effective COVID-19 vaccines has been hindered by financial, logistical and political barriers. Of concern is increasing vaccine hesitancy caused by unfounded conspiracy theories of vaccine adverse effects, often fueled by misinformation and disinformation on social media.

EXPERT OPINION

This perspective discusses the potential impact of the so-called autoimmune/autoinflammatory syndrome caused by adjuvants (ASIA) on COVID-19 vaccine uptake. Proponents of the ASIA syndrome have inappropriately linked infertility to HPV vaccines and have recently suggested antigenic cross-reactivity between SARS-CoV-2 and ovarian follicles. COVID-19 vaccines have also been linked to ASIA and unfounded fear of infertility is a leading cause of vaccine hesitancy. Vaccine hesitancy caused by spurious disorders such as ASIA are likely to harm individuals and delay global vaccination efforts leading to emergence of vaccine and monoclonal antibody resistant mutants, thereby prolonging the COVID-19 pandemic.

Chinese parents' willingness to vaccinate their children against COVID-19: A systematic review and meta-analysis

Introduction

To evaluate Chinese parents' willingness to vaccinate their children against COVID-19, identify its predictors, and provide a reference for raising the COVID-19 vaccination rate for children.

Method

PubMed, Cochrane Library, Embase, and the databases in Chinese, including CNKI, WanFang, VIP, CBM, were searched from December 2019 to June 2022, and citation tracking was used to identify relevant studies. To calculate the rate with 95% confidence intervals (CI), a random-effects model was used. To explore sources of heterogeneity, sensitivity analysis and subgroup analysis were conducted. This analysis was registered on PROSPERO (CRD42022346866) and reported in compliance with the PRISMA guidelines.

Result

Overall, 80 studies were screened, and 13 studies with 47994 parents were included after removing duplicates and excluding 19 studies that did not meet the selection criteria by title, abstract and full-text screening. The pooled willingness rate of Chinese parents to vaccinate their children against COVID-19 was 70.0% (95% CI: 62.0~78.0%). Level of education, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination (such as perceived efficacy and safety of the COVID-19 vaccines, parental willingness to vaccinate themselves, parental vaccination hesitancy, and the history of children's vaccination against influenza) were the main predictors of parents' intention to vaccinate their children.

Discussion

Chinese parents' willingness to vaccinate their children against COVID-19 is moderate, and factors including parental education level, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination affect this decision. Fully identifying these factors and their mechanism will be essential to further raise the willingness rate.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022346866.