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Wachinger J, Reñosa MDC, Endoma V, Landicho-Guevarra J, McMahon SA. Routines, disruptions, revised decisions: A biographical analysis of vaccination trajectories among Filipino caregivers. Vaccine 2024; 42:126095. [PMID: 38972765 DOI: 10.1016/j.vaccine.2024.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/26/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Individuals' vaccine attitudes and practices are not static, but instead are shaped and iteratively revised based on new information and experiences. Understanding shifts over the life course could inform novel approaches and indicate opportune points for communicating vaccine information, but little is known about individuals' vaccination biographies, particularly in low- and middle-income countries. METHODS To explore vaccination biographies in a setting marked by high proportions of vaccine hesitancy and recent large-scale vaccination discourses, we conducted and biographically analyzed n = 29 narrative in-depth interviews with caregivers of small children in the Philippines. RESULTS Our results outline how the perceived relevance of vaccination and an individual's own attitudes and practices repeatedly changed over the course of their life. While respondents narrated vague memories of early vaccine encounters in their families, at schools, or during vaccination campaigns, vaccine relevance accelerated drastically during respondents' or their partner's first perinatal period. Over the following life phase as caregivers, respondents described iterative shifts in their vaccine stance (based on their own experiences, broader discourses, or changing contexts) until their youngest child 'graduated' from immunization. Respondents' later adulthood and old age were commonly marked by little engagement with immunization (except for the COVID-19 vaccines), until the birth of grandchildren sparked renewed motivation to guide younger generations (whether for or against vaccination). CONCLUSIONS The relevance of vaccination and associated attitudes or practices repeatedly change over the life course. Vaccine promotion efforts could incorporate these biographical dynamics to align with respondents' informational needs, for example by increased engagement in first perinatal periods, eye-level communication at later phases to acknowledge caregivers' increased sense of expertise, and encouragement of vaccine confident grandparents to engage in younger generations' vaccination decisions. Future research should explore transgenerational vaccine trajectories and the potential of biographically targeted promotion efforts.
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Affiliation(s)
- Jonas Wachinger
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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2
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Kalu IC, Wagner BE, Armstrong SC, Permar S, Coffman S, Freeman C, D'Agostino EM. Mitigation measures against Coronavirus Disease 2019 (COVID-19) in overnight faith-based camps: summer 2021. Public Health 2024; 232:82-85. [PMID: 38749152 DOI: 10.1016/j.puhe.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/21/2024] [Accepted: 04/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE In this study, we describe community-based nonpharmaceutical interventions (NPIs) incorporated into COVID-19 mitigation protocols, and SARS-CoV-2 incidence at five faith-based summer camps in the US. STUDY DESIGN Retrospective cohort study. METHODS Six southeastern states within the United States (13 sites) were assessed from May 30 to August 14, 2021 (13 sites; N = 13,132; May-August 2021). Camp mitigation policies and NPIs (including masking, vaccinations, meal arrangements, physical distancing, pre-arrival testing, symptom screening, quarantine/isolation, and ventilation upgrades), and SARS-CoV-2 infections were tracked at each site. RESULTS The symptomatic primary case attack rate was 24.7 (range: 0.0-120.0) cases per 100,000 people per week. Fewer infections were observed in camps with greater mitigation protocols. CONCLUSION These findings suggest that nonpharmaceutical mitigation can promote stable access to youth programs for historically vaccine-hesitant subgroups. Policy recommendations for nonpharmaceutical interventions to prevent respiratory viral transmission in overnight youth faith-based camp settings may include outdoor activities, accessible symptomatic tests, prearrival testing, indoor mask use, small cohorts, physical distancing, and protocols to minimize staff exposures during time off.
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Affiliation(s)
- I C Kalu
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - B E Wagner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA.
| | - S C Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - S Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - S Coffman
- YMCA of the Triangle, Raleigh, NC, USA
| | - C Freeman
- Duke Divinity School, Durham, NC, USA
| | - E M D'Agostino
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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3
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Langer S, Holzapfel S, August L, Badura A, Wellmann S, Mack I. Parental knowledge and attitudes to infant immunization in the context of RSV: All about confidence? Vaccine 2024:S0264-410X(24)00689-3. [PMID: 38902186 DOI: 10.1016/j.vaccine.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/29/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Recently, the first RSV vaccines have been approved, but vaccine hesitancy still poses great challenges to immunization programs. OBJECTIVE To investigate this phenomenon in the context of the new RSV vaccines and an increased virus activity in 2022/23, we assessed parental knowledge and attitudes towards general childhood and RSV vaccines. METHODS Parents of infants from 0-36 months completed an online questionnaire on demographics, socio-economic status, mental well-being, knowledge on RSV and perceptions of disease, attitudes to general childhood and RSV vaccines. The survey was conducted from February-June 2023 in the region of Regensburg, Germany. We compared continuous or categorical data with two-sided t-tests or Chi-square tests, respectively. Linear and logistic regression models were used to adjust for confounders. RESULTS From 191 survey participants, 84 % had never refused any recommended vaccination and 91 % trusted their paediatrician's information. 11 % felt that children should have fewer vaccinations or rather get over the illness. Parents who were supportive or undecided about RSV vaccination were less likely to be vaccine hesitant in general (OR 0.03, p < 0.001; OR 0.13, p = 0.003). 58 % reported to have basic or good knowledge on RSV, correlating with a higher socioeconomic index (p = 0.049). 24 % were undecided about RSV immunization, while all parents rated its benefit high in the child's first year of life. Parents who refused RSV vaccination were less concerned about the infection compared to vaccine supporters (OR 0.44, p < 0.001). Parents with previously hospitalized (OR 3.88, p = 0.017) or preterm born children (OR 5.12, p = 0.026) were generally more concerned. CONCLUSION Many factors influence parental decision-making leading to three main groups of attitudes: vaccine acceptors, refusers and hesitant but accessible parents. They (24%) represent the "target group" to increase vaccine uptake. Information on the vaccine-preventable disease reduces vaccine hesitancy, underlining the importance of healthcare professionals who remain an important source of trust.
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Affiliation(s)
- Simon Langer
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sabrina Holzapfel
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Lara August
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Anna Badura
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sven Wellmann
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Ines Mack
- Department of Neonatology, Children's University Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany; Department of Paediatric Infectious Diseases and Vaccinology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland.
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Vuolanto P, Almeida AN, Anderson A, Auvinen P, Beja A, Bracke P, Cardano M, Ceuterick M, Correia T, De Vito E, Delaruelle K, Delicado A, Esposito M, Ferrara M, Gariglio L, Guerreiro C, Marhánková JH, Hilário AP, Hobson-West P, Iorio J, Järvinen KM, Koivu A, Kotherová Z, Kuusipalo A, Lermytte E, Mendonça J, Morais R, Numerato D, Polak P, Rudek T, Sbaragli S, Scavarda A, Silva K, da Silva PA, Sivelä J, Moura ES, Świątkiewicz-mośny M, Tipaldo G, Wagner A. Trust matters: The Addressing Vaccine Hesitancy in Europe Study. Scand J Public Health 2024; 52:379-390. [PMID: 38346923 PMCID: PMC11067405 DOI: 10.1177/14034948231223791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 05/04/2024]
Abstract
This article presents the design of a seven-country study focusing on childhood vaccines, Addressing Vaccine Hesitancy in Europe (VAX-TRUST), developed during the COVID-19 pandemic. The study consists of (a) situation analysis of vaccine hesitancy (examination of individual, socio-demographic and macro-level factors of vaccine hesitancy and analysis of media coverage on vaccines and vaccination and (b) participant observation and in-depth interviews of healthcare professionals and vaccine-hesitant parents. These analyses were used to design interventions aimed at increasing awareness on the complexity of vaccine hesitancy among healthcare professionals involved in discussing childhood vaccines with parents. We present the selection of countries and regions, the conceptual basis of the study, details of the data collection and the process of designing and evaluating the interventions, as well as the potential impact of the study. Laying out our research design serves as an example of how to translate complex public health issues into social scientific study and methods.
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Affiliation(s)
- Pia Vuolanto
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | | | | | - Petra Auvinen
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - André Beja
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - Piet Bracke
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Mario Cardano
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Melissa Ceuterick
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Tiago Correia
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - Elisabetta De Vito
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Katrijn Delaruelle
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Ana Delicado
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Maurizio Esposito
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Maria Ferrara
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Luigi Gariglio
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Cátia Guerreiro
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | | | | | - Pru Hobson-West
- University of Nottingham, School of Sociology and Social Policy, UK
| | - Juliana Iorio
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Katri-Maria Järvinen
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Annariina Koivu
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Zuzana Kotherová
- Charles University, Faculty of Social Sciences, the Czech Republic
| | - Aapo Kuusipalo
- Tampere University, Faculty of Social Sciences, Research Center for Knowledge, Science, Technology and Innovation Studies, Finland
| | - Esther Lermytte
- Ghent University, Department of Sociology, Health and Demographic Research, Belgium
| | - Joana Mendonça
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Rita Morais
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | - Dino Numerato
- Charles University, Faculty of Social Sciences, the Czech Republic
| | - Paulina Polak
- Jagiellonian University, Institute of Sociology, Poland
| | - Tadeusz Rudek
- Jagiellonian University, Institute of Sociology, Poland
| | - Sara Sbaragli
- University of Cassino and Southern Lazio, Department of Human, Social and Health Sciences, Italy
| | - Alice Scavarda
- University of Turin, Department of Cultures, Politics and Society, Italy
| | - Katielle Silva
- Universidade de Lisboa, Instituto de Ciências Sociais, Portugal
| | | | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Cultural, Behavioural and Media Insights Center, Finland
| | - Eva Soares Moura
- Charles University, Faculty of Social Sciences, the Czech Republic
| | | | - Giuseppe Tipaldo
- University of Turin, Department of Cultures, Politics and Society, Italy
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5
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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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6
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Fadl N, Abdelmoneim SA, Gebreal A, Youssef N, Ghazy RM. Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy. Public Health 2024; 226:66-73. [PMID: 38007843 DOI: 10.1016/j.puhe.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries. STUDY DESIGN A cross-sectional study was conducted from November 1 to December 15, 2022. METHODS Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed. RESULTS Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168). CONCLUSIONS Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.
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Affiliation(s)
- N Fadl
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - S A Abdelmoneim
- Clinical Research Administration, Directorate of Health Affairs, Egyptian Ministry of Health, Alexandria, Egypt.
| | - A Gebreal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - N Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Saudi Arabia.
| | - R M Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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7
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Abstract
Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy.
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Affiliation(s)
- Emma Jones
- School of Health, Te Herenga Waka, Victoria University of Wellington, 22 Trusham Court, Paraparaumu 5032, New Zealand
| | - Eva Neely
- School of Health, Te Herenga Waka, Victoria University of Wellington, 22 Trusham Court, Paraparaumu 5032, New Zealand
- School of Health, Te Herenga Waka, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand
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8
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de Melo EB, Almeida PD, Pereira BM, Borges PDTM, Gir E, de Araújo TME. Vaccination hesitation in children under five years of age: a scoping review. Rev Bras Enferm 2023; 76:e20220707. [PMID: 38018617 PMCID: PMC10680390 DOI: 10.1590/0034-7167-2022-0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/08/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES to synthesize scientific evidence on vaccine hesitancy in children under five years of age and its associated factors. METHODS a scoping review, conducted according to the methodological structure proposed by the JBI. Searches were carried out in the Latin American and Caribbean Center on Health Sciences Information, Scientific Electronic Library Online and PubMed databases, including gray literature. Studies in English, Spanish and Portuguese were included, without temporal delimitation. Editorials, studies that did not address vaccine hesitancy in children under five years of age and were not aligned with the objective and research question were excluded. The sample consisted of 18 articles. RESULTS misinformation, concern about adverse effects, distrust about efficacy, affliction regarding administration simultaneously, and insecurity in relation to the laboratories were the reported reasons. CONCLUSIONS strategies are needed to combat the lack of information about immunobiological agents, as misinformation was the main factor in parents' vaccine hesitation.
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Affiliation(s)
| | | | | | | | - Elucir Gir
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
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9
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Fasce A, Schmid P, Holford DL, Bates L, Gurevych I, Lewandowsky S. A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling. Nat Hum Behav 2023; 7:1462-1480. [PMID: 37460761 DOI: 10.1038/s41562-023-01644-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2023] [Indexed: 09/23/2023]
Abstract
The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.
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Affiliation(s)
- Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn L Holford
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Essex, Colchester, UK
| | - Luke Bates
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Iryna Gurevych
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychology, University of Potsdam, Potsdam, Germany
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10
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Kikut AI. The doctor knows or the evidence shows: An online survey experiment testing the effects of source trust, pro-vaccine evidence, and dual-processing in expert messages recommending child COVID-19 vaccination to parents. PLoS One 2023; 18:e0288272. [PMID: 37478116 PMCID: PMC10361505 DOI: 10.1371/journal.pone.0288272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/24/2023] [Indexed: 07/23/2023] Open
Abstract
Increasing child vaccination rates is a critical step toward mitigating the spread of COVID-19. Both distrust in expert sources and concern about the safety and efficacy of vaccines may contribute to parent vaccine hesitancy. The present study is the first to test the effectiveness of building trust and providing evidence supporting child COVID-19 vaccines in recommendation messages for parents. Based on dual-processing theories, emphasis on source trustworthiness and pro-vaccine evidence may each be particularly effective when the other is not present. It was hypothesized that these two approaches would have main and interaction effects on perceived message effectiveness and pro-vaccine beliefs. A between-subjects 2 (trust-building appeal vs. no trust-building appeal) X 2 (pro-vaccine evidence vs. no pro-vaccine evidence) online survey experiment was conducted in December 2021 and January 2022 with United States parents/guardians of children <18 years old (n = 401). As hypothesized, trust and pro-vaccine evidence each had significant simple main effects on both outcomes. Analysis of variance showed a significant negative interaction effect of trust and pro-vaccine evidence on perceived message effectiveness [F(3, 394) = 6.47; η2 = 0.02, p = 0.002; 95% CI (0.01, 0.11)], supporting the dual-processing hypothesis. The interaction effect on pro-vaccine beliefs was also negative but not significant [F(3, 394) = 2.69; η2 = 0.01; p = 0.102; 95% CI (0.00, 0.03)]. Either highlighting evidence supporting vaccines or building trust in expert sources can influence parent vaccine support. Messages which include strong evidence supporting recommended behaviors may influence recommendation acceptance even among those with lower trust in expert sources and establishing trust may reduce the need to describe available evidence.
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Affiliation(s)
- Ava Irysa Kikut
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Pulgaron ER, D’Agostino EM, Johnson SB, Ko LK, Drain PK, Duran MC, Keener Mast D, Kay S, Layer MA, Kenworthy T, Dozier A. Reflections From School Communities in Underserved Populations on Childhood COVID-19 Vaccination. Pediatrics 2023; 152:e2022060352M. [PMID: 37394501 PMCID: PMC10312275 DOI: 10.1542/peds.2022-060352m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Outbreaks in vaccine-preventable diseases among children have increased, primarily among under- or unvaccinated subgroups. The influence and interaction of a child's school community on parental health care decisions, such as vaccination, has not been explored. Our study examined childhood coronavirus disease 2019 (COVID-19) vaccine hesitancy within the context of school communities. METHODS This study combines data from 4 independent research studies funded by the National Institutes of Health Rapid Acceleration of Diagnostics Underserved Populations Return to School Initiative. We examined focus group data to better understand the apprehension surrounding parental and child COVID-19 vaccination among underserved school populations. RESULTS Across all study sites, 7 main themes emerged with regard to COVID-19-related vaccination concerns for children: (1) potential side effects, (2) vaccine development, (3) misinformation (subthemes: content of vaccine and negative intent of the vaccine), (4) vaccine effectiveness, (5) timing of vaccine administration/availability for children, (6) fear of needles, and (7) mistrust. CONCLUSIONS School settings offered unique access to youth and family perspectives in underserved communities. Our studies highlighted several factors contributing to COVID-19 vaccine hesitancy in school communities, which align with existing literature on vaccine hesitancy. These concerns centered primarily on potential harm of vaccines, as well as misinformation, mistrust, and timing of vaccines. Related recommendations for increasing vaccination rates are provided. Developing specific strategies that address parent and child concerns will be critical to reducing health inequities related to COVID-19 vaccination.
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Affiliation(s)
- Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Emily M. D’Agostino
- Departments of Orthopedic Surgery
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Linda K. Ko
- Department of Health Systems and Population Health
| | - Paul K. Drain
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | | | | | | | | | - Tara Kenworthy
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann Dozier
- Public Health Sciences, University of Rochester, Rochester, New York
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Marvila Garcia É, Lima de Souza E, Penido Matozinhos F, Moreira Ribeiro da Silva T, Alves Waldman E, Sato APS. Associated factors with vaccine hesitancy in mothers of children up to two years old in a Brazilian city. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002026. [PMID: 37289722 DOI: 10.1371/journal.pgph.0002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023]
Abstract
This study aims to evaluate maternal vaccine hesitancy and its associated factors. This is a cross-sectional study of a probabilistic sample of 450 mothers of children born in 2015, living in a Brazilian city, and who was, at the time of data collection, more than two years old. We used the tool proposed by the World Health Organization (10-item Vaccine Hesitancy Scale). To assess its structure, we performed, exploratory and confirmatory factor analyses. We performed linear regression models to evaluate the factors associated with vaccine hesitancy. The factor analysis showed two components for the vaccine hesitancy scale: lack of confidence in vaccines and risk perception of vaccines. High family income was associated with lower vaccine hesitancy (greater confidence in vaccines and lower risk perception of vaccines), while the presence of other children, regardless of birth order, in the family was associated with lower confidence in vaccines. A good rapport with health professionals, willingness to wait for the vaccination and the getting vaccinated through campaigns were associated with greater confidence in vaccines. The deliberate delay or decision not to vaccinate their children and previous experience with adverse reactions to the vaccine were associated with lower confidence in vaccines and greater risk perception of vaccines. Health care providers, especially nurses, play a relevant role to address vaccine hesitancy, guiding vaccination through a trustworthy rapport.
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13
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First hepatitis B vaccine uptake in neonates prior to and during the COVID-19 pandemic. Vaccine 2023; 41:2824-2828. [PMID: 36997387 PMCID: PMC10040361 DOI: 10.1016/j.vaccine.2023.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Introduction Routine vaccination for hepatitis B is recommended at birth, and most infants should be vaccinated within 24 h of life. Historically, vaccination rates have been less than ideal, and routine vaccination has been further complicated by the COVID-19 pandemic, with decreased uptake of many vaccines. This retrospective study assessed hepatitis B vaccination rates at birth before and after the start of the COVID-19 pandemic and explored the factors associated with lower vaccination rates. Methods Infants born at a single academic medical center in Charleston, South Carolina from November 1, 2018 through June 30, 2021 were identified. Infants were excluded if they died or received ≥ 7 days of systemic steroid therapy within the first 37 days of life. Maternal and infant baseline characteristics and uptake of the first hepatitis B vaccine during hospital admission were recorded. Results A total of 7808 infants were included in the final analysis, with an overall vaccine uptake of 91.6 %. Of the 3880 neonates in the pre-pandemic group, 3583 (92.3 %) were vaccinated, versus 3571 (90.9 %) of 3928 neonates in the pandemic group (rate difference = 1.4 %; 95 % confidence interval −2.8 % to 5.7 %, p = 0.52). Factors independently associated with lower vaccine uptake included being of non-Hispanic white race, born to a married mother, birth weight < 2 kg, and parental refusal of erythromycin eye ointment at birth. Conclusion The COVID-19 pandemic did not significantly affect the uptake of inpatient neonatal hepatitis B vaccination. Several patient-specific factors were associated with suboptimal vaccination rates in this population.
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Cordella B, Signore F, Andreassi S, De Dominicis S, Gennaro A, Iuso S, Mannarini T, Kerusauskaite S, Kosic A, Reho M, Rochira A, Rocchi G, Salvatore S. How socio-institutional contexts and cultural worldviews relate to COVID-19 acceptance rates: A representative study in Italy. Soc Sci Med 2023; 320:115671. [PMID: 36702028 PMCID: PMC9839458 DOI: 10.1016/j.socscimed.2023.115671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
RATIONALE Despite its importance to counter the COVID-19 pandemic, vaccination has raised hesitation in large segments of the population. This hesitation makes it important to understand the mechanisms underlying vaccine acceptance. To this end, the study adopts the Semiotic Cultural Psychology Theory, holding that social behaviors - and therefore, vaccination acceptance - depend on the cultural meanings in terms of which people interpret the social world. OBJECTIVE The study aims at estimating the impact a) of the way people interpret the socio-institutional context of the pandemic and b) of the underlying cultural worldviews on vaccine acceptance. More particularly, the study tested the three following hypotheses. a) The meanings grounding the interpretation of the socio-institutional framework - that is, trust in institutions and political values - are an antecedent of vaccination acceptance. b) The impact of these meanings is moderated by the cultural worldviews (operationalized as symbolic universes). And c), the magnitude of the symbolic universes' moderator effect depends on the uncertainty to which the respondent is exposed. The exposure to uncertainty was estimated in terms of socioeconomic status - the lower the status, the high the exposure to uncertainty. METHODS An Italian representative sample (N = 3020) completed a questionnaire, measuring vaccination acceptance, the meanings attributed to the socio-institutional context - that is, political values and trust in institutions - and symbolic universes. RESULTS The findings were consistent with the hypotheses. a) Structural equation modelling proved that vaccine acceptance was predicted by trust in institutions. b) Multigroup analysis revealed that symbolic universes moderated the correlation between trust in institutions and vaccine acceptance. And c), the moderation effect of symbolic universes proved to occur only in the segment of lower socio-economic status (i.e., the group exposed to higher uncertainty). CONCLUSIONS Vaccination acceptance is not only a medical issue; it is also dependent upon the rationalization of the socio-institutional context. Implications for the promotion of vaccination acceptance are discussed.
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Affiliation(s)
- Barbara Cordella
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | - Fulvio Signore
- Department of Human and Social Sciences, University of Salento, Via di Valesio 24, 73100, Lecce, Italy
| | - Silvia Andreassi
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | | | - Alessandro Gennaro
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | - Salvatore Iuso
- Department of Clinical and Experimental Medicine, University of Foggia, Via A. Gramsci, N. 89/91, 71122, Foggia, Italy
| | - Terri Mannarini
- Department of Human and Social Sciences, University of Salento, Via di Valesio 24, 73100, Lecce, Italy
| | - Skaiste Kerusauskaite
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | - Ankica Kosic
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via Dei Marsi, 78, 00185, Rome, Italy
| | - Matteo Reho
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | - Alessia Rochira
- Department of Human and Social Sciences, University of Salento, Via di Valesio 24, 73100, Lecce, Italy
| | - Giulia Rocchi
- Department of Dynamic and Clinical Psychology, And Health Studies, Sapienza University of Rome, Via Degli Apuli, 1, 00183, Rome, Italy
| | - Sergio Salvatore
- Department of Human and Social Sciences, University of Salento, Via di Valesio 24, 73100, Lecce, Italy.
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Durmuş Sarıkahya S, Güden E, Sümeyye Yorulmaz D. Childhood vaccine hesitancy in two regions with different socioeconomic backgrounds in Turkey. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-10. [PMID: 36855466 PMCID: PMC9948781 DOI: 10.1007/s10389-023-01854-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
Aim This study investigated childhood vaccine hesitancy in two regions with different socioeconomic backgrounds in Kayseri, Turkey. Subject and methods The study population consisted of all people over 18 years of age admitted to two family health centers (No 65 and 103) in a city center for any reason. Results Participants living in the high socioeconomic status (SES) region had a significantly lower mean rating on the CVHQ (Childhood Vaccine Hesitancy Questionnaire - see below) than those living in the low SES region. Conclusion Vaccine hesitancy is the main reason for vaccine refusal. Therefore, authorities should provide adequate and accurate information about the significance of vaccines to raise public awareness.
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Affiliation(s)
| | - Emel Güden
- Kayseri Provincial Health Directorate, AR-GE Project Management and Consultancy Unit, Kayseri, Türkiye
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Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, Marcuse EK, Ali A, Dunn J, Hofstetter AM. Sometimes Your Heart Says 'I Don't Know': Insights From Parents of Undervaccinated Children. Acad Pediatr 2023; 23:57-67. [PMID: 36228981 DOI: 10.1016/j.acap.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To explore drivers of suboptimal vaccination rates by understanding why parents without strong antivaccine beliefs do not fully vaccinate their children. METHODS Four focus groups were conducted in Washington state with 41 parents of children aged 24 to 48 months who delayed, declined, or missed some but not all vaccines. During the focus groups, parents were asked about reasons their child was undervaccinated, information that might address their concerns, and additional support they needed. Transcripts were analyzed using template analysis with deductive and inductive codes. RESULTS Focus groups identified multiple reasons for parents deciding to delay or decline vaccines for their children, including issues of individualism and control. The groups emphasized the impact of personal circumstances, such as changes in insurance, on whether children were vaccinated. Our data also shed light on the reasons that parents do vaccinate their children, including school vaccination requirements, negative experiences with vaccine-preventable diseases, and a family tradition of vaccinating. Focus group participants offered suggestions for improving vaccine communication with parents such as having more parent/patient-friendly vaccine information, providing forums to discuss their concerns, and offering vaccination information in advance of well-child appointments. CONCLUSIONS To achieve the full benefit of vaccines on individual and community health, we need better ways to address vaccine hesitancy and decrease barriers. We suggest that many hesitant parents would benefit from more dialog with health care providers about vaccines, more approachable educational materials, and enforcement of existing policies requiring vaccines in schools and childcare facilities.
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Affiliation(s)
- Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute (C Hsu, S Evers, and J Dunn), Seattle, Wash.
| | - Sarah Evers
- Kaiser Permanente Washington Health Research Institute (C Hsu, S Evers, and J Dunn), Seattle, Wash
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington School of Medicine (A Ibrahim, EK Marcuse, and AM Hofstetter), Seattle, Wash; Somali Health Board (A Ibrahim and A Ali), Tukwila, Wash
| | - M Patricia
- Washington State Department of Health (M Patricia deHart, P Throne, and AM Hofstetter), Tumwater, Wash
| | - Paul Throne
- Washington State Department of Health (M Patricia deHart, P Throne, and AM Hofstetter), Tumwater, Wash
| | | | - Edgar K Marcuse
- Department of Pediatrics, University of Washington School of Medicine (A Ibrahim, EK Marcuse, and AM Hofstetter), Seattle, Wash; Seattle Children's Research Institute (EK Marcuse), Seattle, Wash
| | - Ahmed Ali
- Somali Health Board (A Ibrahim and A Ali), Tukwila, Wash
| | - John Dunn
- Kaiser Permanente Washington Health Research Institute (C Hsu, S Evers, and J Dunn), Seattle, Wash
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington School of Medicine (A Ibrahim, EK Marcuse, and AM Hofstetter), Seattle, Wash; Washington State Department of Health (M Patricia deHart, P Throne, and AM Hofstetter), Tumwater, Wash
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Smith SE, Sivertsen N, Lines L, De Bellis A. Decision making in vaccine hesitant parents and pregnant women - An integrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100062. [PMID: 38745627 PMCID: PMC11080481 DOI: 10.1016/j.ijnsa.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives : Vaccine refusal is increasing in Australia and is a major concern in high- and middle-income countries. There is evidence to suggest that some parents, even those who elect to immunise, may be vaccine hesitant with some manipulating the schedule by excluding or delaying some vaccines. The aim of this review was to gain an understanding of factors that influence vaccine decision-making in pregnant women and parents of children. Design : An integrative review approach was used to produce an analysis of existing literature on vaccine decision-making in pregnancy and parents. As the broadest of review methods, an integrative review can include a range of experimental and non-experimental research, thereby ensuring the inclusion of data from multiple perspectives. Data Sources : Online databases were searched for research related to vaccine decision-making in pregnant women and parents. Original and review articles were sought that were published in English between 2015 and 2021. Reviewed articles included qualitative and quantitative studies and systematic reviews. No mixed methods papers were located or excluded from this review. Review methods : The review method was an integrative review informed by Coughlan. Results : Papers from thirteen predominantly high- and middle-income countries were selected for this review. A total of 31 articles fit the inclusion/exclusion criteria, including qualitative, quantitative and review articles. Three main themes were identified including the role of healthcare professionals, vaccine safety concerns and alternative influences. Alternative influences included: social media, friends and family, religion, conspiracy theories and salutogenic parenting. Findings suggest that high levels of anxiety are involved in vaccine decision-making with parents seeking information from multiple sources including healthcare professionals, friends and family and social media. Conclusions : Pregnancy is an ideal time to provide education on both pregnancy and childhood vaccinations. However, some parents reported dissatisfaction in their therapeutic relationships with healthcare professionals. As a result, parents can resort to their own information seeking, in the main via social media which has been linked to vaccine refusal. Additionally, some healthcare professionals report feeling inadequately prepared for the role of immunisation promotion and provision. Parental information seeking from non-traditional sources has been shown to result in the acquisition of misinformation, exposure to conspiracy theories, the inevitable loss of vaccine confidence and subsequent vaccine refusal.
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Affiliation(s)
- Susan E Smith
- Flinders University College of nursing and health science, Australia
| | - Nina Sivertsen
- Flinders University College of nursing and health science, Australia
- Arctic University of Norway, Rural and Remote Arctic Health, Campus Hammersfest
| | - Lauren Lines
- Flinders University College of nursing and health science, Australia
| | - Anita De Bellis
- Flinders University College of nursing and health science, Australia
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Jamison KC, Ahmed AH, Spoerner DA, Kinney D. Best shot: A motivational interviewing approach to address vaccine hesitancy in pediatric outpatient settings. J Pediatr Nurs 2022; 67:124-131. [PMID: 36108393 DOI: 10.1016/j.pedn.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vaccine hesitancy in parents and childhood vaccine refusal is increasing. A standard of care to address this problem has not been identified. PURPOSE To identify if the use of motivational interviewing by pediatric providers during routine well child visits, when compared to standard of care, would increase vaccine rates in children 0-12 months of age. Factors associated with vaccine hesitancy were also investigated. METHODS A quasi-experimental study was completed on a convenience sample of pediatric providers (N = 6) and caregivers of children 0-12 months of age (N = 66). Four providers were trained to use motivational interviewing. During the well child visit the Parent Attitudes About Childhood Vaccines survey was completed, and the motivational interviewing intervention was implemented. Clinic's data were compared with other clinic data of non-trained providers. FINDINGS Vaccine refusal/delays rate was 11.4% among caregivers. Vaccine refusal rate decreased after the intervention (9.00% pre-intervention and 6.40% post-intervention). An ordinal regression identified caregivers with higher vaccine hesitancy scores and more children were more likely to delay or refuse vaccines, while caregivers ≥30 years or with high income were less likely to delay/refuse vaccines. A difference in difference analysis identified that an additional 2.6% of children received vaccines when seen by trained providers compared to non-trained (β = -0.330, OR = 0.719, p = 0.470). DISCUSSION Findings indicate a condensed motivational interviewing education session may be clinically significant in decreasing vaccine hesitancy among this population. APPLICATIONS TO PRACTICE A more robust study to confirm these findings is recommended prior to practice implementation.
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Affiliation(s)
- Kristin C Jamison
- Advanced Practice Nursing, Beacon Medical Group, Indiana, United States; Purdue University School of Nursing, 502 North University Street, West Lafayette, IN 47907, United States.
| | - Azza H Ahmed
- Purdue University School of Nursing, 502 North University Street, West Lafayette, IN 47907, United States.
| | - Deborah A Spoerner
- Purdue University School of Nursing, 502 North University Street, West Lafayette, IN 47907, United States.
| | - Daniel Kinney
- Pediatrician, Beacon Medical Group, 1815 E Ireland Rd, South Bend, Indiana, United States.
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Ghirotto L, Díaz Crescitelli ME, De Panfilis L, Caselli L, Serafini A, De Fiore L, Galeazzi GM, Costantini M. Italian health professionals on the mandatory COVID-19 vaccine: An online cross-sectional survey. Front Public Health 2022; 10:1015090. [PMID: 36339217 PMCID: PMC9629863 DOI: 10.3389/fpubh.2022.1015090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/28/2022] [Indexed: 01/27/2023] Open
Abstract
Italy was the first country in Europe to make vaccination against COVID-19 mandatory for healthcare professionals by imposing restrictions in cases of non-compliance. This study investigates the opinions of the Italian healthcare professionals' categories affected by the regulation. We performed a qualitative online survey: the questionnaire comprised both close- and open-ended questions. The final dataset included n = 4,677 valid responses. Responses to closed-ended questions were analyzed with descriptive statistics. The framework method was applied for analyzing the open-ended questions. The sample spanned all health professions subject to compulsory vaccination, with a prevalence of physicians (43.8%) and nurses (26.3%). The vaccine adhesion before the introduction of the obligation was substantial. 10.4% declared not to have adhered to the vaccination proposal. Thirty-five percent of HPs who opted not to get vaccinated said they experienced consequences related to their choice. The trust in the vaccine seems slightly cracked, demonstrating overall vaccine confidence among professionals. Nonetheless, our results show that whether (or not) professionals adhere to vaccination is not a reliable indicator of consent to how it was achieved. There are criticisms about the lawfulness of the obligation. The data show a great variety of participants interpreting their roles concerning public and individual ethics. The scientific evidence motivates ethics-related decisions-the epidemic of confusing and incorrect information affected professionals. The Law triggered an increased disaffection with the health system and conflicts between professionals. Dealing with the working climate should be a commitment to assume soon.
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Affiliation(s)
- Luca Ghirotto
- Qualitative Research Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Luca Ghirotto
| | | | | | - Luana Caselli
- Scientific Directorate, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Arianna Serafini
- Scientific Directorate, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Department of Mental Health and Drug Abuse, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Costantini
- Scientific Directorate, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Lee Mortensen G, Harrod-Lui K. Parental knowledge about respiratory syncytial virus (RSV) and attitudes to infant immunization with monoclonal antibodies. Expert Rev Vaccines 2022; 21:1523-1531. [PMID: 35929971 DOI: 10.1080/14760584.2022.2108799] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ninety percent of all children are infected with respiratory syncytial virus (RSV) within their first two years of life. RSV is the main cause behind hospitalization of infants with lower respiratory tract infections. A new monoclonal antibody (mAb) immunization may prevent RSV in all infants. This cross-national study aimed to examine parental knowledge about RSV and attitudes to such RSV immunization. RESEARCH DESIGN AND METHODS Based on a literature study, a questionnaire was designed and applied in a survey carried out in China, France, Germany, Italy, Japan, Spain, the UK, and the US. Eligible respondents were expecting their first baby or parents of children <24 months old who were open to vaccination. RESULTS Parental acceptance of immunizations relies on perceptions of the preventable disease. In 5627 parents, only 35% reported basic or good level of knowledge about RSV. Recommendation from health care professionals and inclusion in immunization programs were crucial to their acceptance of RSV immunization. If recommended and informed about its efficacy and safety, most parents would accept RSV mAb immunization for their infants. CONCLUSIONS Infant RSV infections are highly prevalent, yet parental awareness of RSV is poor. Country variations call for targeted communication about RSV and immunization.
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Nurses’ Influenza Vaccination and Hesitancy: A Systematic Review of Qualitative Literature. Vaccines (Basel) 2022; 10:vaccines10070997. [PMID: 35891161 PMCID: PMC9320778 DOI: 10.3390/vaccines10070997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Vaccine hesitancy (VH) is defined as “delaying or refusing a secure vaccine despite its availability”. This hesitancy affects caregivers and more specifically nurses. The purpose of this study is to assess determinants of influenza VH in the nurse’s community. We conducted a systematic review of qualitative literature according to criteria of Preferred Reporting Items for Systematic Review and Meta-Analysis and Enhancing Transparency in Reporting the synthesis of Qualitative Research from 2009 until October 2020. Eleven qualitative studies analysed (ten thematic content analyses and one grounded theory method) found three main factors in VH. The first determinant was the benefit–risk equation considered as unfavourable due to an ineffective vaccine and fears about adverse effects as the pain of the injection. Wrong immunological beliefs brought into hesitancy. Disease barriers (hand washing and masks) and personal immunity were regarded as more effective than the vaccine. Lastly, dehumanised vaccination and the difficulties of access to healthcare were institutional determinants. Nurses ask for a vaccine promotion by hierarchy and doctors with transparent information and respect for autonomy. The availability of vaccines and methods of pain control seem to be some tracks to reduce nurses’ VH.
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Boyle J, Nowak G, Kinder R, Iachan R, Dayton J. Better Understanding Adult COVID-19 Vaccination Hesitancy and Refusal: The Influence of Broader Beliefs about Vaccines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116838. [PMID: 35682421 PMCID: PMC9180283 DOI: 10.3390/ijerph19116838] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
Published surveys in the United States provide much evidence that COVID-19 vaccination is influenced by disease and vaccine-related risk perceptions. However, there has been little examination of whether individual’s general beliefs about vaccines are also related to COVID-19 vaccination, especially among unvaccinated adults. This study used an August 2021 national survey of 1000 U.S. adults to examine whether general beliefs about vaccines were associated with COVID-19 vaccination status. In addition, it used multivariate analyses to assess the relative contribution of individual vaccine beliefs to current vaccine status independently of COVID-19-specific attitudes and experiences, and demographics. The findings indicated that, collectively, general vaccine beliefs mattered more than demographics, COVID-19-specific risk perceptions, confidence in government, or trust in public health agencies in COVID-19 vaccination status. Overall, the findings affirm the importance of vaccine education and communication efforts that help people understand why vaccines are needed, how vaccine safety is established and monitored, and how vaccines provide protection from infectious diseases. To achieve success among vaccine-hesitant individuals, communication strategies should target vaccine beliefs that most influence vaccination outcomes.
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Affiliation(s)
- John Boyle
- ICF International, Rockville, MD 20850, USA; (J.B.); (R.I.); (J.D.)
| | - Glen Nowak
- Center for Health & Risk Communication, College of Journalism and Mass Communication, University of Georgia, Athens, GA 30602, USA;
| | - Rachel Kinder
- ICF International, Rockville, MD 20850, USA; (J.B.); (R.I.); (J.D.)
- Correspondence:
| | - Ronaldo Iachan
- ICF International, Rockville, MD 20850, USA; (J.B.); (R.I.); (J.D.)
| | - James Dayton
- ICF International, Rockville, MD 20850, USA; (J.B.); (R.I.); (J.D.)
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Gearing Up for a Vaccine Requirement: A Mixed Methods Study of COVID-19 Vaccine Confidence Among Workers at an Academic Medical Center. J Healthc Manag 2022; 67:206-220. [PMID: 35576446 DOI: 10.1097/jhm-d-21-00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL Assessing barriers to vaccination among healthcare workers may be particularly important given their roles in their respective communities. We conducted a mixed methods study to explore healthcare worker perspectives on receiving COVID-19 vaccines at a large multisite academic medical center. METHODS A total of 5,917 employees completed the COVID-19 vaccine confidence survey (20% response rate). Most participants were vaccinated (93%). Compared to vaccinated participants, unvaccinated participants were younger (60% < 44 years), more likely to be from a non-Asian minority group (48%), and more likely to be nonclinical employees (57% vs. 46%). Among the unvaccinated respondents, 53% indicated they would be influenced by their healthcare provider, while 19% reported that nothing would influence them to get vaccinated. Key perceived barriers to vaccination from the qualitative analysis included the need for more long-term safety and efficacy data, a belief in the right to make an individual choice, mistrust, a desire for greater public health information, personal health concerns, circumstances such as prior COVID-19 infection, and access issues. PRINCIPAL FINDINGS Strategies endorsed by some participants to address their concerns about safety and access included a communication campaign, personalized medicine approaches (e.g., individual appointments to discuss how the vaccine might interact with personal health conditions), and days off to recover. Mistrust and a belief in the right to make an individual choice may be harder barriers to overcome; further dialogue is needed. APPLICATIONS TO PRACTICE These findings reflect potential strategies for vaccine requirements that healthcare organizations can implement to enhance vaccine confidence. In addition, organizations can ask respected health professionals to serve as spokespeople, which may help shift the perspectives of unvaccinated healthcare workers.
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Schuster L, Gurrieri L, Dootson P. Emotions of burden, intensive mothering and COVID-19 vaccine hesitancy. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2061917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Lisa Schuster
- Qut Business School, Queensland University of Technology, Brisbane, Australia
| | - Lauren Gurrieri
- School of Economics, Finance and Marketing, Rmit University, Melbourne, Australia
| | - Paula Dootson
- Qut Business School, Queensland University of Technology, Brisbane, Australia
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26
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Mønsted B, Lehmann S. Characterizing polarization in online vaccine discourse-A large-scale study. PLoS One 2022; 17:e0263746. [PMID: 35139121 PMCID: PMC8827439 DOI: 10.1371/journal.pone.0263746] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/23/2022] [Indexed: 01/02/2023] Open
Abstract
Vaccine hesitancy is currently recognized by the WHO as a major threat to global health. Recently, especially during the COVID-19 pandemic, there has been a growing interest in the role of social media in the propagation of false information and fringe narratives regarding vaccination. Using a sample of approximately 60 billion tweets, we conduct a large-scale analysis of the vaccine discourse on Twitter. We use methods from deep learning and transfer learning to estimate the vaccine sentiments expressed in tweets, then categorize individual-level user attitude towards vaccines. Drawing on an interaction graph representing mutual interactions between users, we analyze the interplay between vaccine stances, interaction network, and the information sources shared by users in vaccine-related contexts. We find that strongly anti-vaccine users frequently share content from sources of a commercial nature; typically sources which sell alternative health products for profit. An interesting aspect of this finding is that concerns regarding commercial conflicts of interests are often cited as one of the major factors in vaccine hesitancy. Further, we show that the debate is highly polarized, in the sense that users with similar stances on vaccination interact preferentially with one another. Extending this insight, we provide evidence of an epistemic echo chamber effect, where users are exposed to highly dissimilar sources of vaccine information, depending the vaccination stance of their contacts. Our findings highlight the importance of understanding and addressing vaccine mis- and dis-information in the context in which they are disseminated in social networks.
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Affiliation(s)
- Bjarke Mønsted
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Sune Lehmann
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
- Center for Social Data Science, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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27
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Weighing up the risks — Vaccine decision-making in pregnancy and parenting. Women Birth 2022; 35:547-552. [DOI: 10.1016/j.wombi.2022.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
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28
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Mekonnen BD, Mengistu BA. COVID-19 vaccine acceptance and its associated factors in Ethiopia: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 14:101001. [PMID: 35284688 PMCID: PMC8898789 DOI: 10.1016/j.cegh.2022.101001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/12/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background COVID-19 vaccination is considered as an effective intervention for controlling the burden of the pandemic. However, vaccine hesitation is increasing and hindering efforts targeting to reduce the burden of the COVID-19 disease. Hence, determining COVID-19 vaccine acceptance and identifying determinants that would hinder people to vaccinate against COVID-19 is crucial to effectively improve COVID-19 vaccine uptake. In Ethiopia, the pooled proportion of COVID-19 vaccine acceptance and its determinants is not well known. Thus, the aim of this study is to estimate the pooled proportion of COVID-19 vaccine acceptance and its determinants in Ethiopia. Methods A systematic search of articles was conducted from PubMed, Scopus, Web of Science, MEDLINE, CINAHL, Science Direct and Cochrane Library. Data were extracted using a data extraction tool which was adapted from the Joanna Briggs Institute. The quality of each included primary studies was evaluated using the Newcastle-Ottawa scale tool. Data analysis was performed using STATA 14. Heterogeneity in studies was assessed using Cochrane Q and I2 test. Publication bias was assessed using visual inspection of funnel plots and Egger's test. A random effects model was applied to determine the pooled estimates if heterogeneity was exhibited; otherwise, a fixed-effects model was used. Results A total of 14 studies involving 6373 participants were included for the final analysis. The pooled proportion of COVID-19 vaccine acceptance in Ethiopia was 56.02% (95% CI: 47.84, 64.20). The likelihood of COVID-19 vaccine acceptance was higher among participants who had history of chronic disease (AOR = 1.33, 95% CI: 1.09, 2.97), good knowledge (AOR = 2.13, 95% CI: 1.59, 4.97), positive attitude (AOR = 2.23, 95% CI: 1.21, 4.66), good COVID-19 preventive practice (AOR = 1.97, 95% CI: 1.82, 2.12), and high perceived seriousness of COVID-19 (AOR = 3.21, 95% CI: 2.32, 5.98). Conclusion More than half participants were willing to accept COVID-19 vaccine. Thus, awareness creation battles about the efficacy and safety of the COVID-19 vaccine should be provided to the community. Besides, policy-makers, health planners and other stakeholders should encourage COVID-19 vaccine uptake behaviors by providing trusted information.Systematic review and meta-analysis registration: PROSPERO CRD42021264708.
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Affiliation(s)
- Birye Dessalegn Mekonnen
- Department of Nursing, Teda Health Science College, P.O.BOX: 790, Gondar, Ethiopia,Corresponding author
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Klugar M, Riad A, Mohanan L, Pokorná A. COVID-19 Vaccine Booster Hesitancy (VBH) of Healthcare Workers in Czechia: National Cross-Sectional Study. Vaccines (Basel) 2021; 9:1437. [PMID: 34960183 PMCID: PMC8705445 DOI: 10.3390/vaccines9121437] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/11/2022] Open
Abstract
The emerging SARS-CoV-2 variants and waning vaccine-elicited immunity are two public health challenges that occurred simultaneously and synergistically during the summer of 2021 and led to a surging demand for COVID-19 vaccine booster dose (BD) rollout. This study aimed to evaluate the COVID-19 vaccine booster hesitancy (VBH) among Czech healthcare workers to explore the potential determinants of VBH. A national cross-sectional survey-based study was carried out between 3 and 11 November 2021, using an online self-administered questionnaire (SAQ) that explored the participants' demographic characteristics, COVID-19 infection and vaccine anamneses, willingness to receive COVID-19 vaccine BD, and the psychosocial drivers of VBH. A total of 3454 HCW properly responded to the online SAQ, of which 80.9% were females, 30.3% were medical professionals, and 50.5% were ≤47 years old. Most of the participants were already inoculated against SARS-CoV-2 (95.2%), and BTN162b2 was the most commonly administered vaccine (90.7%). As the study sample was planned to represent the target population, it revealed a high level of BD acceptance (71.3%) among Czech HCW, while 12.2% were still hesitant and 16.6% were against the currently available BD. These results are consistent with other recent results from central Europe. Medical professional, male, and older participants were more likely to accept BD rather than allied health professional, female, and younger participants. The BDs' perceived effectiveness against severe illness, symptomatic infection, and community transmission was a significant and strong predictor for BD acceptance, while the effectiveness against the circulating variants was not that important for our target population. The BDs' perceived safety and ethical dilemmas of vaccine justice should be addressed sufficiently while communicating with HCW and other population groups. The altruistic reasons for BD acceptance, i.e., family protection, patient protection, and community health protection, underpin the recommendation of postponing the COVID-19 vaccine mandating in favour of stressing these altruistic concerns amid public health messaging.
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Affiliation(s)
- Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (L.M.); (A.P.)
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, 128 01 Prague, Czech Republic
| | - Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (L.M.); (A.P.)
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Lekshmi Mohanan
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (L.M.); (A.P.)
| | - Andrea Pokorná
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (L.M.); (A.P.)
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, 128 01 Prague, Czech Republic
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30
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Wiley KE, Leask J, Attwell K, Helps C, Barclay L, Ward PR, Carter SM. Stigmatized for standing up for my child: A qualitative study of non-vaccinating parents in Australia. SSM Popul Health 2021; 16:100926. [PMID: 34604497 PMCID: PMC8473775 DOI: 10.1016/j.ssmph.2021.100926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaccine refusal is highly polarizing in Australia, producing a challenging social landscape for non-vaccinating parents. We sought to understand the lived experience of non-vaccinating parents in contemporary Australia. METHODS We recruited a national sample of non-vaccinating parents of children <18 yrs, advertising on national radio, in playgrounds in low vaccination areas, and using snowballing. Grounded Theory methodology guided data collection (via semi-structured interviews). Inductive analysis identified stigmatization as a central concept; stigma theory was adopted as an analytical lens. RESULTS Twenty-one parents from regional and urban locations in five states were interviewed. Parent's described experiences point to systematic stigmatization which can be characterized using Link & Phelan's five-step process. Parents experienced (1) labelling and (2) stereotyping, with many not identifying with the "anti-vaxxers" portrayed in the media and describing frustration at being labelled as such, believing they were defending their child from harm. Participants described (3) social "othering", leading to relationship loss and social isolation, and (4) status loss and discrimination, feeling "brushed off" as incompetent parents and discriminated against by medical professionals and other parents. Finally, (5) legislative changes exerted power over their circumstances, rendering them unable to provide their children with the same financial and educational opportunities as vaccinated children, often increasing their steadfastness in refusing vaccination. CONCLUSION Non-vaccinating Australian parents feel stigmatized for defending their child from perceived risk of harm, reporting a range of social and psychological effects, as well as financial effects from policies which disadvantaged their children through differential financial treatment, and diminished early childhood educational opportunities. While it might be argued that social stigma and exclusionary policies directed a small minority for the greater good are justified, other more nuanced approaches based on better understandings of vaccine rejection could achieve comparable public health outcomes without the detrimental effect on unvaccinated families.
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Affiliation(s)
- Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
| | - Julie Leask
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Katie Attwell
- School of Social Sciences, Faculty of Arts, Business, Law and Education, University of Western Australia, Australia
| | - Catherine Helps
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Lesley Barclay
- University Centre for Rural Health, Sydney School of Public Health, University of Sydney, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Stacy M. Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), University of Wollongong, Australia
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31
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Ecker F, Kutalek R. 'I'm not an anti-vaxer!'-vaccine hesitancy among physicians: a qualitative study. Eur J Public Health 2021; 31:1157-1163. [PMID: 34580713 PMCID: PMC8675240 DOI: 10.1093/eurpub/ckab174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Over the last years, research interest in vaccine hesitancy has increased. Studies usually focus on perceptions of parents and have largely neglected the group of health care providers. However, doctors' notions on vaccination have a major impact on the decision-making process of their patients. We were interested to understand the phenomenon of vaccine hesitancy among physicians, with a particular focus on the measles vaccine. Furthermore, we aimed to understand the underlying perceptions of measles that may be associated with vaccine hesitant decisions. METHODS In order to get an in-depth view, semi-structured interviews with physicians were conducted. Doctors were eligible for the study if they articulated vaccine hesitant views and/or demonstrated vaccine hesitancy in their medical practice. RESULTS We interviewed 12 physicians, of whom 11 had a medical practice with no contract with the Austrian social insurance ('Wahlarzt') and additional training in complementary and alternative medicine. We found perceptions of immunology, health and illness that were discordant with evidence-based medicine and closely related to alternative and complementary medicine. All participants argued for a delayed administration of the measles vaccine. We found a consistent inclination towards 'individual vaccination', which was explained as empowering parents and to strengthen their decision-making competencies. Most participants expressed doubts about the reliability of vaccine studies and were concerned with possible long-term effects. CONCLUSIONS Paying closer attention to doctors' concerns on vaccination might help to design target-oriented interventions to specifically strengthen vaccine confidence.
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Affiliation(s)
- Franziska Ecker
- Department of Social and Preventive Medicine, Center
for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Center
for Public Health, Medical University of Vienna, Vienna, Austria
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32
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Feng H, Zhu H, Zhang H, Cao L, Li L, Wang J, Huang Y, Lai X, Lyu Y, Jing R, Guo J, Yin Z, Fang H. Caregivers' intentions to COVID-19 vaccination for their children in China: a cross-sectional survey. Hum Vaccin Immunother 2021; 17:4799-4805. [PMID: 34756123 DOI: 10.1080/21645515.2021.1985355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chinese caregivers' intentions to allow their children to be vaccinated against coronavirus disease 2019 (COVID-19) is unknown. We explored the intention rate of Chinese caregivers to allow their children to be vaccinated and examined potential influencing factors and underlying reasons for their unwillingness or hesitation. From November 30, 2020, to January 31, 2021, we conducted a cross-sectional survey of 3703 caregivers in six representative provinces in China. We assessed intention rates and correlates of caregivers' intentions to vaccinate children against COVID-19, using descriptive analyses and a multiple logistic regression analysis, respectively. In the study sample, about 84.0% of caregivers intended to get their children vaccinated for COVID-19 if the vaccine was available. In particular, 92.2% of caregivers who were willing to be vaccinated themselves for COVID-19 intended to have their children vaccinated, yet among caregivers who were unwilling (or uncertain) whether to be vaccinated, only 41.1% intended to have their children vaccinated. Older age, lower education level, and perceived safety and effectiveness of the COVID-19 vaccine were associated with increased odds of caregivers intending to have their children vaccinated. Of the six provinces included in the study, residence in a province other than Hubei increased the likelihood that caregivers would choose not to have their children vaccinated. We found a relatively high vaccination rate (84.0%) among caregivers by using a cross-sectional sample in China. Concerted efforts are needed to address caregivers' concerns about vaccine safety, especially among caregivers who do not intend to be vaccinated themselves.
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Affiliation(s)
- Huangyufei Feng
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Lingsheng Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaohao Wang
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Yingzhe Huang
- Department of Statistics, Beijing Weikexing Technology, Beijing, China
| | - Xiaozhen Lai
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Yun Lyu
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Rize Jing
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Jia Guo
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China.,Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing, China.,Key Laboratory of Reproductive Health National Health Commission of the People's Republic of China, Beijing, China
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Macinotsh JLB, Rowberry C, Peterson N, Luthy KE, Beckstrand R. Responding to Questions from Parents with Vaccine Concerns. J Pediatr Health Care 2021; 35:601-609. [PMID: 34479757 DOI: 10.1016/j.pedhc.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Even with the benefits of vaccinations, some parents refuse vaccinations because of the influence of vaccine opponents. The purpose of this article is to identify common vaccine concerns on public forums and address these concerns with scientific evidence, thereby offering pediatric nurse practitioners (PNPs) information on how to respond. METHOD Six electronic databases were searched to identify parental concerns regarding vaccines and provide evidence-based responses to each concern. RESULTS Some parents are concerned that health care providers do not obtain written informed consent before vaccinating their children. Another common concern is that pharmaceutical companies are solely motivated by financial profits when manufacturing vaccines. Parents also share concerns about vaccine manufacturers' exemption from liability for those who suffer a vaccine-related injury. DISCUSSION PNPs are responsible for addressing parents' concerns regarding vaccines and providing the public with correct information. PNPs are in a prime position to influence parental vaccine decision-making positively.
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Evans S, Klas A, Mikocka-Walus A, German B, Rogers G, Ling M, Fernando J, Kothe E, Westrupp E. "Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions. J Psychosom Res 2021; 150:110626. [PMID: 34583017 PMCID: PMC8503786 DOI: 10.1016/j.jpsychores.2021.110626] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children. METHOD This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children. RESULTS 64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information. CONCLUSION Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.
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Affiliation(s)
- S. Evans
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Corresponding author at: School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - A. Klas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - A. Mikocka-Walus
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - B. German
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - G.D. Rogers
- School of Medicine, Deakin University, Victoria, Australia
| | - M. Ling
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - J.W. Fernando
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - E. Kothe
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - E.M. Westrupp
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia,Judith Lumley Centre, La Trobe University, Victoria, Australia
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Tsimtsiou Z, Tatsioni A, Gkizlis V, Kolokas K, Papaioannou A, Birka S, Tirodimos I, Tsiligianni I. Under-Vaccination in Adults: Qualitative Insights Into Perceived Barriers Reported by Vaccine Supporters, Undecided and Refuters. J Prim Prev 2021; 42:625-640. [PMID: 34657269 PMCID: PMC8520579 DOI: 10.1007/s10935-021-00650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 01/18/2023]
Abstract
Although vaccination is one of the most cost-effective ways of preventing disease, vaccine hesitancy has been included among the ten threats of global health. Addressing low adult vaccination rates requires an adequate understanding of people's views. We explored perceived barriers to immunization among under-vaccinated adults to identify potential differences among vaccine supporters, refuters, and those who are undecided. We conducted a multi-center, mixed-methods study at 23 primary care practices in Greece. Each day, we asked three new randomly-selected adult healthcare users who attended the practice over the course of 30 consecutive working days. We used thematic content analysis to analyze their written answers to open-ended questions that addressed reasons for not getting vaccinated. Out of 1571 participants, two-thirds reported they were under-vaccinated as adults, thus accounting for three out of five of the supporters and the vast majority of the undecided and refuters. “Concerns/fears,” a “perception of low susceptibility to disease due to good health status,” the “absence of healthcare professional’s recommendation,” and “previous negative experiences” were four themes common to all three groups. Additional barriers reported by supporters and the undecided included “knowledge gaps about the necessity of adult vaccination,” “negligence,” and lack of “accessibility.” Among refuters, additional themes identified were “mistrust in pharmaceutical companies” and “disbelief in vaccine effectiveness.” In conclusion, under-vaccination is common, not only among refuters or the undecided, but also among supporters of adult vaccination. We found similarities and differences in under-vaccinated adults’ perceived barriers, depending on their individual perspectives. Physicians and public health services should take into consideration the impact of the wide range of attitudes and beliefs in their effort to address the underlying barriers to vaccination compliance as they attempt to increase vaccination coverage in adults.
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Affiliation(s)
- Zoi Tsimtsiou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece. .,Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece. .,Health Center of Evosmos, Tegopoulou 2 & Patron Street, 56224, Thessaloniki, Greece.
| | - Athina Tatsioni
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Vasileios Gkizlis
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,Rural Practice of Mavrommati, 43060, Mavrommati, Karditsa, Greece
| | - Konstantinos Kolokas
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,3Rd Local Health Unit of Evosmos, Kosma Aitolou 1, 56224, Thessaloniki, Greece
| | - Anastasia Papaioannou
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,Health Center of N. Makri, Artemidos & Marathonos Avenue, 19005, Athens, Greece
| | - Sofia Birka
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,Health Center of Evosmos, Tegopoulou 2 & Patron Street, 56224, Thessaloniki, Greece
| | - Ilias Tirodimos
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Ioanna Tsiligianni
- Research Committee of Greek Association of General Practitioners, 54625, Thessaloniki, Greece.,Department of Social Medicine, Faculty of Medicine, University of Crete, 71003, Heraklion Crete, Greece
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Riad A, Huang Y, Abdulqader H, Morgado M, Domnori S, Koščík M, Mendes JJ, Klugar M, Kateeb E. Universal Predictors of Dental Students' Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach. Vaccines (Basel) 2021; 9:1158. [PMID: 34696266 PMCID: PMC8539257 DOI: 10.3390/vaccines9101158] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND young adults represent a critical target for mass-vaccination strategies of COVID-19 that aim to achieve herd immunity. Healthcare students, including dental students, are perceived as the upper echelon of health literacy; therefore, their health-related beliefs, attitudes and behaviors influence their peers and communities. The main aim of this study was to synthesize a data-driven model for the predictors of COVID-19 vaccine willingness among dental students. METHODS a secondary analysis of data extracted from a recently conducted multi-center and multi-national cross-sectional study of dental students' attitudes towards COVID-19 vaccination in 22 countries was carried out utilizing decision tree and regression analyses. Based on previous literature, a proposed conceptual model was developed and tested through a machine learning approach to elicit factors related to dental students' willingness to get the COVID-19 vaccine. RESULTS machine learning analysis suggested five important predictors of COVID-19 vaccination willingness among dental students globally, i.e., the economic level of the country where the student lives and studies, the individual's trust of the pharmaceutical industry, the individual's misconception of natural immunity, the individual's belief of vaccines risk-benefit-ratio, and the individual's attitudes toward novel vaccines. CONCLUSIONS according to the socio-ecological theory, the country's economic level was the only contextual predictor, while the rest were individual predictors. Future research is recommended to be designed in a longitudinal fashion to facilitate evaluating the proposed model. The interventions of controlling vaccine hesitancy among the youth population may benefit from improving their views of the risk-benefit ratio of COVID-19 vaccines. Moreover, healthcare students, including dental students, will likely benefit from increasing their awareness of immunization and infectious diseases through curricular amendments.
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Affiliation(s)
- Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (M.K.)
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Yi Huang
- Department of Psychology, Faculty of Social Studies, Masaryk University, 602 00 Brno, Czech Republic;
- Institute for Research of Children, Youth and Family, Faculty of Social Studies, Masaryk University, 602 00 Brno, Czech Republic
| | - Huthaifa Abdulqader
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
| | - Mariana Morgado
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
- Clinical Research Unit (CRU), Egas Moniz Cooperativa de Ensino Superior, 2829-511 Almada, Portugal;
| | - Silvi Domnori
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
| | - Michal Koščík
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (M.K.)
| | - José João Mendes
- Clinical Research Unit (CRU), Egas Moniz Cooperativa de Ensino Superior, 2829-511 Almada, Portugal;
| | - Miloslav Klugar
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (M.K.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Elham Kateeb
- Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem 510 00, Palestine;
- Public Health Committee, World Dental Federation (FDI), 1216 Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy. RECENT FINDINGS Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context. SUMMARY Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa D, Trevena L, Thomas S, Danchin M. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Glob Health 2021; 6:bmjgh-2021-006860. [PMID: 34580071 PMCID: PMC8477248 DOI: 10.1136/bmjgh-2021-006860] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia .,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - David N Durrheim
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel Costa
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Susan Thomas
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Wang Q, Yang L, Jin H, Lin L. Vaccination against COVID-19: A systematic review and meta-analysis of acceptability and its predictors. Prev Med 2021; 150:106694. [PMID: 34171345 PMCID: PMC8217737 DOI: 10.1016/j.ypmed.2021.106694] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 01/02/2023]
Abstract
We aimed to estimate the coronavirus disease 2019 (COVID-19) vaccine acceptance rate and identify predictors associated with acceptance. To this end, we searched PubMed, Web of Science, Cochrane Library, and Embase databases until November 4, 2020. Meta-analyses were performed to estimate the rate with 95% confidence intervals (CI). Predictors were identified to be associated with vaccination intention based on the health belief model framework. Thirty-eight articles, with 81,173 individuals, were included. The pooled COVID-19 vaccine acceptance rate was 73.31% (95%CI: 70.52, 76.01). Studies using representative samples reported a rate of 73.16%. The pooled acceptance rate among the general population (81.65%) was higher than that among healthcare workers (65.65%). Gender, educational level, influenza vaccination history, and trust in the government were strong predictors of COVID-19 vaccination willingness. People who received an influenza vaccination in the last year were more likely to accept COVID-19 vaccination (odds ratio: 3.165; 95%CI: 1.842, 5.464). Protecting oneself or others was the main reason for willingness, and concerns about side effects and safety were the main reasons for unwillingness. National- and individual-level interventions can be implemented to improve COVID-19 vaccine acceptance before large-scale vaccine rollout. Greater efforts could be put into addressing negative predictors associated with willingness.
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Affiliation(s)
- Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
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Landicho-Guevarra J, Reñosa MDC, Wachinger J, Endoma V, Aligato MF, Bravo TA, Landicho J, Bärnighausen K, McMahon SA. Scared, powerless, insulted and embarrassed: hesitancy towards vaccines among caregivers in Cavite Province, the Philippines. BMJ Glob Health 2021; 6:e006529. [PMID: 34475024 PMCID: PMC8413880 DOI: 10.1136/bmjgh-2021-006529] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several studies have highlighted that vaccine hesitancy (VH) is among the most important threats to global health, especially in low- and middle-income countries, including the Philippines. However, there is a dearth of literature exploring family experiences of-or concerns related to-childhood vaccinations that gives voice to vaccine hesitant caregivers (VHCs) of small children. Here, we present insights from VHCs from the Philippines. METHODS This research draws on in-depth interviews (IDIs) with 44 VHCs who had previously delayed or refused vaccination for their children in rural and urban communities in Cavite Province, the Philippines. Amid the COVID-19 pandemic, we conducted IDIs via an online platform of the respondents' choosing (ie, Facebook messenger call, Skype and Zoom). All interviews were recorded, transcribed, translated and analysed drawing from the tenets of constructivist grounded theory. We use the social ecological model to structure our results. RESULTS Among the reasons for delay or refusal of childhood vaccinations, a fear of side effects emerged as the most salient concern, exacerbated by previous negative experiences (including trauma) from a dengue vaccine controversy in 2017. Respondents cited the dengue vaccine controversy as they expressed reluctance (regarding any new vaccines) and suspicion (towards school-based vaccination, the distribution channel used for the dengue vaccine). Heads of households opposing vaccines, perceptions that vaccines are non-essential and influences from the social and traditional media or neighbours contributed to further refusal and delay. Upon probing, VHCs recounted health system concerns particularly with regards to healthcare workers who are sometimes unable to answer their questions and can be dismissive or disrespectful regarding caregivers' concerns. CONCLUSION Understanding VH from the lens of VHCs highlights pathways for interventions to regain trust and bolster confidence towards vaccines. Our findings may serve as linchpins in the development of VH interventions aiming at changing behaviour on a population scale.
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Affiliation(s)
- Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | - Mark Donald C Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Riad A, Schünemann H, Attia S, Peričić TP, Žuljević MF, Jürisson M, Kalda R, Lang K, Morankar S, Yesuf EA, Mekhemar M, Danso-Appiah A, Sofi-Mahmudi A, Pérez-Gaxiola G, Dziedzic A, Apóstolo J, Cardoso D, Marc J, Moreno-Casbas M, Wiysonge CS, Qaseem A, Gryschek A, Tadić I, Hussain S, Khan MA, Klugarova J, Pokorna A, Koščík M, Klugar M. COVID-19 Vaccines Safety Tracking (CoVaST): Protocol of a Multi-Center Prospective Cohort Study for Active Surveillance of COVID-19 Vaccines' Side Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7859. [PMID: 34360156 PMCID: PMC8345554 DOI: 10.3390/ijerph18157859] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. METHODS A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses' side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869. CONCLUSIONS CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines.
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Affiliation(s)
- Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (S.H.); (J.K.); (A.P.)
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic;
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1, Canada;
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Tina Poklepović Peričić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia;
| | - Marija Franka Žuljević
- Department of Medical Humanities, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia;
| | - Mikk Jürisson
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia; (M.J.); (R.K.); (K.L.)
| | - Ruth Kalda
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia; (M.J.); (R.K.); (K.L.)
| | - Katrin Lang
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia; (M.J.); (R.K.); (K.L.)
| | - Sudhakar Morankar
- Faculty of Public Health, Institute of Health, Jimma University, Aba Jifar 1 Street, 378 Jimma, Ethiopia; (S.M.); (E.A.Y.)
| | - Elias Ali Yesuf
- Faculty of Public Health, Institute of Health, Jimma University, Aba Jifar 1 Street, 378 Jimma, Ethiopia; (S.M.); (E.A.Y.)
| | - Mohamed Mekhemar
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Arnold-Heller-Str. 3, Haus B, 24105 Kiel, Germany;
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra LG 25, Ghana;
| | - Ahmad Sofi-Mahmudi
- Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran 16846, Iran;
| | - Giordano Pérez-Gaxiola
- Department of Evidence Based Medicine, Sinaloa Pediatric Hospital, Cochrane Mexico, Calle Constitución 530, Jorge Almada, 80200 Culiacán, Mexico;
| | - Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland;
| | - João Apóstolo
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence-Based Practice: JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (J.A.); (D.C.)
| | - Daniela Cardoso
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence-Based Practice: JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (J.A.); (D.C.)
| | - Janja Marc
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva Cesta 7, 1000 Ljubljana, Slovenia;
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Mayte Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa;
| | - Amir Qaseem
- American College of Physicians, 190 N Independence Mall W, Philadelphia, PA 19106, USA;
| | - Anna Gryschek
- Department of Nursing in Collective Health, School of Nursing, University of São Paulo, São Paulo 419, Brazil;
| | - Ivana Tadić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia;
| | - Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (S.H.); (J.K.); (A.P.)
| | - Mohammed Ahmed Khan
- School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India;
| | - Jitka Klugarova
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (S.H.); (J.K.); (A.P.)
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic;
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 375/4, 128 01 Praha 2, Czech Republic
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Andrea Pokorna
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (S.H.); (J.K.); (A.P.)
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 375/4, 128 01 Praha 2, Czech Republic
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Michal Koščík
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic;
- Czech Clinical Research Infrastructure Network, Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (A.R.); (S.H.); (J.K.); (A.P.)
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic;
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 375/4, 128 01 Praha 2, Czech Republic
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
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Ebrahimi OV, Johnson MS, Ebling S, Amundsen OM, Halsøy Ø, Hoffart A, Skjerdingstad N, Johnson SU. Risk, Trust, and Flawed Assumptions: Vaccine Hesitancy During the COVID-19 Pandemic. Front Public Health 2021; 9:700213. [PMID: 34277557 PMCID: PMC8281037 DOI: 10.3389/fpubh.2021.700213] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon. Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy. Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy. Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.
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Affiliation(s)
- Omid V. Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Miriam S. Johnson
- Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway
| | - Sara Ebling
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Øyvind Halsøy
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | | | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
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Padilla-Bernáldez J, Cruz-Piqueras M, Hortal-Carmona J. [To inhabit (and vaccinate) in Omelas: an ethic of us]. GACETA SANITARIA 2021; 35:509-511. [PMID: 34172311 DOI: 10.1016/j.gaceta.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Javier Padilla-Bernáldez
- Centro de Salud Rafael Alberti, Madrid, España; Red de Ética Salubrista para la Acción, Cuidados y Observación Social (ESPACyOS), España; Colectivo Silesia, España.
| | - Maite Cruz-Piqueras
- Red de Ética Salubrista para la Acción, Cuidados y Observación Social (ESPACyOS), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Joaquín Hortal-Carmona
- Red de Ética Salubrista para la Acción, Cuidados y Observación Social (ESPACyOS), España; Centro de Salud Albayzín, Servicio Andaluz de Salud, Granada, España
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Ye L, Chen J, Fang T, Ma R, Wang J, Pan X, Dong H, Xu G. Vaccination coverage estimates and utilization patterns of inactivated enterovirus 71 vaccine post vaccine introduction in Ningbo, China. BMC Public Health 2021; 21:1118. [PMID: 34112128 PMCID: PMC8194148 DOI: 10.1186/s12889-021-11198-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background In China, enterovirus 71 (EV71) is the major etiological agents of hand foot mouth disease that poses severe risks to children’s health. Since 2015, three inactivated EV71 vaccines have been approved for use. Previous studies indicated the high willingness of EV71 vaccination in eastern China. However, few studies have assessed coverage and utilization patterns of EV71 vaccine in China. Methods Children born during 2012–2018 were sampled and their records were abstracted from Ningbo childhood immunization information management system. Descriptive statistics characterized the study population and assessed coverage and timeliness for EV71 vaccination. Simultaneous administration patterns as well as type of EV71 vaccine used were also evaluated. Bivariate and multivariable analysis was used to examine the relationship of socio-demographic characteristics with vaccination coverage and timeliness. Results Of 716,178 children living in Ningbo. One hundred seventy-two thousand two hundred thirty-six received EV71 vaccine with a coverage rate of 24.05% and only 8.61% received vaccination timely. 21.97% of children received the complete two dose EV71 series but only 6.49% completed timely. Vaccination coverage and timeliness increased significantly from 2012 birth cohort to 2018 birth cohort. Relatively higher coverage and timeliness were observed in resident children, Inner districts, high socioeconomic areas and large-scaled immunization clinics. Of 329,569 doses of EV71 vaccine, only 5853(1.78%) doses were administered at the same day as other vaccines. Conclusions There is a need for increasing EV71 vaccination coverage and timeliness as well as eliminating disparities among different populations. Our study highlights the importance of simultaneous administration to increasing coverage and timeliness of EV71 vaccination.
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Affiliation(s)
- Lixia Ye
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Jieping Chen
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Ting Fang
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Rui Ma
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Jianmei Wang
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Xingqiang Pan
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Hongjun Dong
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China
| | - Guozhang Xu
- Ningbo Municipal Center for Disease Prevention and Control, Institute of Immunization and Prevention, Yongfeng Road, Haishu District, Ningbo, 315010, China.
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Musa S, Kulo A, Bach Habersaat K, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vaccin Immunother 2021; 17:3023-3033. [PMID: 34081562 DOI: 10.1080/21645515.2021.1923346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Vaccination coverage in the Federation of Bosnia and Herzegovina, in Bosnia and Herzegovina, has been declining since 2014. This qualitative study aimed to identify barriers and drivers to childhood vaccination for parents. The COM-B (capability-opportunity-motivation-behavior) model was the underpinning theoretical framework. Face-to-face interviews with 22 parents of fully (n = 6), delayed/partially vaccinated (n = 9) and unvaccinated (n = 7) children were conducted. Interviews explored individual factors (capability-knowledge and skills; motivation-attitudes, confidence and trust) and context factors (physical opportunity-information, access, health systems; and social opportunity - social support, norms). Data were analyzed in NVivo using content analysis exploring differences in COM factors by vaccination status and location. Parents of fully vaccinated children typically reported individual and context drivers to vaccination. They accepted vaccination, trusted health workers, and were content with services. Parents of delayed/partially vaccinated children fell into two subgroups: (1) Those who accepted vaccination and attributed delays to their organizational skills or frustration with appointment times. (2) Those fitting the profile of "vaccine hesitant" - generally valuing vaccination and health worker advice, yet with concerns often triggered by media/social media. Parents of unvaccinated children mentioned individual and context barriers to vaccination, notably significant concerns about safety, some distrust of health workers and resentment of mandatory vaccination. Urban/rural differences included urban parents being more likely to report experiences with vaccine shortages and very few had received information leaflets. The study identified complex and inter-related barriers and drivers to parents' childhood vaccination behaviors. These insights have informed the development of tailored interventions to improve coverage.
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Affiliation(s)
- Sanjin Musa
- Department of Epidemiology, Institute for Public Health of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Aida Kulo
- Institute Of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Venesa Skrijelj
- General Hospital "Prim. Dr Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Mirsad Smjecanin
- Department of Epidemiology, Institute for Public Health of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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Riad A, Abdulqader H, Morgado M, Domnori S, Koščík M, Mendes JJ, Klugar M, Kateeb E. Global Prevalence and Drivers of Dental Students' COVID-19 Vaccine Hesitancy. Vaccines (Basel) 2021; 9:566. [PMID: 34072500 PMCID: PMC8226539 DOI: 10.3390/vaccines9060566] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students' acceptance levels. METHODS A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE. RESULTS A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17-40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; p < 0.01). CONCLUSIONS The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.
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Affiliation(s)
- Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (M.K.); (M.K.)
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Huthaifa Abdulqader
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
| | - Mariana Morgado
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
- Clinical Research Unit (CRU), Egas Moniz Cooperativa de Ensino Superior, 2829-511 Almada, Portugal;
| | - Silvi Domnori
- International Association of Dental Students (IADS), 1216 Geneva, Switzerland; (H.A.); (M.M.); (S.D.)
| | - Michal Koščík
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (M.K.); (M.K.)
| | - José João Mendes
- Clinical Research Unit (CRU), Egas Moniz Cooperativa de Ensino Superior, 2829-511 Almada, Portugal;
| | - Miloslav Klugar
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (M.K.); (M.K.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Elham Kateeb
- Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem 51000, Palestine;
- Public Health Committee, World Dental Federation (FDI), 1216 Geneva, Switzerland
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Vaccine Production Process: How Much Does the General Population Know about This Topic? A Web-Based Survey. Vaccines (Basel) 2021; 9:vaccines9060564. [PMID: 34072288 PMCID: PMC8229207 DOI: 10.3390/vaccines9060564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Vaccine hesitancy has been recognized as a major global health threat by the World Health Organization. Many studies have investigated vaccine safety as a determinant for vaccine hesitancy; however, not much attention has been paid to vaccine production and quality control during the vaccine production process or whether knowledge about this topic may influence vaccine confidence. The aim of this study was to characterize the common knowledge about the vaccine production process. Methods: A freely accessible online questionnaire was developed on Google Modules and disseminated through social networks. A descriptive analysis of the collected answers was performed, and the chi-square test was used to assess significant differences for the sociodemographic characteristics of the study population (age, gender, work or education and training in the healthcare setting, minor offspring). A binary logistic regression model was performed considering these socio-demographic categories as independent variables. Results: The number of collected questionnaire was 135. Most of the participants (127/135, 94.1%) were aware that quality control measures are carried out during manufacturing, although some knowledge gaps emerged in specific aspects of the vaccine production process, without statistically significant differences between age groups. Working in the healthcare setting or being educated in healthcare may be considered predictors for a better understanding that more than 50% of the production time is spent on quality control (AOR = 3.43; 95% CI: 1.84–8.14, p = 0.01) and that considering quality control performed during the vaccine production process is adequate for avoiding contamination (AOR = 7.90; 95% CI: 0.97–64.34; p = 0.05). Conclusions: This study allowed for a characterization of common knowledge about the vaccine production process. It highlighted the need to implement specific strategies to spread correct information about the vaccine production process. This study may contribute to increased confidence and trust in vaccines and vaccination among the general population.
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Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present. BMC Public Health 2021; 21:578. [PMID: 33832447 PMCID: PMC8032458 DOI: 10.1186/s12889-021-10604-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background Communities with low vaccination rates are at greater risk during outbreaks of vaccine preventable diseases. Most Australian parents support vaccines, but some refuse and are often judged harshly by their community, especially during an outbreak. We sought the perspectives of Australian public health experts on the key issues faced when managing a measles outbreak in an area with high anti-vaccination sentiment. Methods A measles outbreak scenario formed the basis of a 3-round modified Delphi process to identify key practitioner concerns in relation to parents/carers who don’t follow the recommended vaccination schedule. We surveyed a range of professionals in the field: policymakers, infectious disease experts, immunisation program staff, and others involved in delivering childhood vaccinations, to identify key priorities when responding to an outbreak in a community with low vaccination coverage. Results Findings indicate that responses to measles outbreaks in communities with high anti-vaccination sentiment are motivated by concerns about the potential for a much larger outbreak event. The highest operational priority is to isolate infected children. The two most highly ranked practical issues are mistrust from non-vaccinating members of the local region and combatting misinformation about vaccines. Trying to change minds of such individuals is not a priority during an outbreak, nor is vaccinating their children. Using media and social media to provide information about the outbreak and measures the public can take to limit the spread of the disease was a focus. Conclusions Our findings provide a deeper understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. In the context of a global pandemic, the results of this study also have implications for managing public health responses to community transmission of SARS-CoV-2, as COVID-19 vaccines becomes widely available. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10604-3.
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Pires C. What Is the State-of-the-Art in Clinical Trials on Vaccine Hesitancy 2015-2020? Vaccines (Basel) 2021; 9:348. [PMID: 33916427 PMCID: PMC8065658 DOI: 10.3390/vaccines9040348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is related to a delay in acceptance or refusal of vaccination. AIM to perform a systematic review of clinical trials on vaccine hesitancy (2015-2020). METHODS a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). Five databases were screened-PubMed, Cochrane Library, DOAJ, SciELO and b-on-which comprise multiple resources. KEYWORDS "Vaccine hesitancy" and ("randomized controlled trial" or "clinical trial"). INCLUSION CRITERIA trials about "vaccine hesitancy" enrolling patients and/or health professionals (2015-2020). EXCLUSION CRITERIA studies about other topics, repeated and qualitative studies, reviews and papers written in languages other than English, Portuguese, French or Spanish. RESULTS a total of 35 trials out of 90 were selected (19 PubMed, 14 Cochrane Library, 0 DOAJ, 0 SciELO and 2 b-on). Selected trials were classified into five topics: children/pediatric (n = 5); online or electronic information (n = 5); vaccination against a specific disease (n = 15) (e.g., influenza or COVID-2019); miscellaneous (n = 4); and educational strategies (n = 6). CONCLUSION the provision of online or electronic information (e.g., through virtual reality, social websites of experts, or apps), communication-based interventions and training of health professionals, residents or subjects seemed to improve vaccine hesitancy.
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Affiliation(s)
- Carla Pires
- Research Center for Biosciences and Health Technologies, CBIOS-Universidade Lusófona de Humanidades e Tecnologias-Escola de Ciências e Tecnologias da Saúde, Campo Grande 376, 1740-024 Lisboa, Portugal
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Vulpe SN, Rughiniş C. Social amplification of risk and "probable vaccine damage": A typology of vaccination beliefs in 28 European countries. Vaccine 2021; 39:1508-1515. [PMID: 33573865 DOI: 10.1016/j.vaccine.2021.01.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite lacking scientific support, vaccine hesitancy is widespread. While serious vaccine damage as a scientific fact is real yet statistically highly uncommon, emerging social and technological forces have amplified perceptions of risk for "probable vaccine damage", making it a widely shared intersubjective reality. METHODS Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis. RESULTS The public beliefs in significant vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: hesitant, confident, and trade-off clusters. The hesitant type (approx. 11% of EU27-UK respondents) is defined by the perception that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with perceptions of probable vaccine damage. The vaccine-confident and the trade-off types have similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior. CONCLUSIONS The high proportion of varying public beliefs in significant vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Communication campaigns should take into account the social normality of the perceived risk of "probable vaccine damage" across various social types, and patterns of concomitant trust and mistrust in vaccination.
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Affiliation(s)
- Simona-Nicoleta Vulpe
- Interdisciplinary School of Doctoral Studies, University of Bucharest, 36-46 Mihail Kogălniceanu, Bucharest, Romania.
| | - Cosima Rughiniş
- Department of Sociology, Faculty of Sociology and Social Work, University of Bucharest, 9 Schitu Măgureanu, Bucharest, Romania
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