Trends, patterns and psychological influences on COVID-19 vaccination intention: Findings from a large prospective community cohort study in England and Wales (Virus Watch)

Willingness to get vaccinated initially and yearly against COVID-19 and its association with vaccine hesitancy, vaccine knowledge and psychological well-being: a cross-sectional study in UK adults

OBJECTIVES

This study explores the association between vaccine hesitancy, vaccine knowledge and psychological well-being with (1) receipt of/willingness to receive an initial vaccine against COVID-19, and (2) willingness to get vaccinated yearly against COVID-19. The importance of different vaccine attributes (eg, vaccine technology, effectiveness, side effects) to choose a specific COVID-19 vaccine was also assessed.

DESIGN

Cross-sectional survey administered during May to June 2021 on vaccine hesitancy, vaccine knowledge, psychological well-being, willingness to receive COVID-19 vaccines, sociodemographics and COVID-19-related factors.

SETTING

UK.

PARTICIPANTS

A self-selected sample of 1408 adults.

OUTCOME MEASURES

Receipt of/willingness to receive COVID-19 vaccine for the first time and yearly.

RESULTS

Receipt of/willingness to receive a vaccine against COVID-19 initially and yearly were high (97.0% and 86.6%, respectively). Vaccine hesitancy was negatively associated with receipt of/willingness to receive vaccine initially/yearly (adjusted OR (aOR)=0.09, 95% CI 0.04 to 0.26, p<0.001/aOR=0.05, 95% CI 0.03 to 0.09, p<0.001). Vaccine knowledge and psychological well-being were positively associated with willingness to receive a yearly vaccine (aOR=1.81, 95% CI 1.43 to 2.29, p<0.001 and aOR=1.25, 95% CI 1.02 to 1.51, p=0.014, respectively), and general vaccine knowledge also with receipt of/willingness to receive vaccine initially (aOR=1.69, 95% CI 1.18 to 2.42, p=0.004). Vaccine effectiveness was the most important attribute for participants to choose a specific COVID-19 vaccine.

CONCLUSIONS

Improving vaccine knowledge and emphasising vaccine efficacy may minimise vaccine hesitancy and increase COVID-19 vaccine uptake.

From intentions to practices: what drove people to get the COVID-19 vaccine? Findings from the French longitudinal socioepidemiological cohort survey

OBJECTIVE

In many countries, before COVID-19 vaccines became available, reluctance to get vaccinated was particularly prevalent among women, the most disadvantaged social groups and ethnoracial minorities, known to be at higher risk for the virus. Using a longitudinal perspective, we analyse the social determinants that are associated with the transition from attitudes towards vaccination to actual vaccination practices.

DESIGN

Representative population-based prospective cohort.

SETTINGS

From November 2020 to July 2021.

PARTICIPANTS

Adults included in the Epidemiology and Living Conditions (EpiCoV) cohort (n=86 701).

MAIN OUTCOME MEASURES

Attitudes towards vaccination in November 2020 before COVID-19 vaccines were available in France (in January 2021) and vaccination practices in July 2021.

RESULTS

Among those who were initially reluctant in November 2020, the youngest, the poorest 10% (OR=0.68, 0.59-0.77), non-European immigrants (OR=0.72, 0.59-0.88) and descendants of non-European immigrants (OR=0.72, 0.61-0.86) were less likely to be vaccinated in July 2021, irrespective of trust in government and scientists. The same social factors were associated with non-vaccination among those who initially were undecided or who favoured vaccination.

CONCLUSION

Despite the fact that COVID-19 vaccines were relatively available and free of charge in France in July 2021, social inequalities in vaccination against the virus remained the same than those observed in vaccination reluctance in November 2020, before vaccines were available. While adjusting for trust, migration background, younger age and lower income were associated with lower vaccination uptake irrespective of initial intention. By neglecting to genuinely target specific groups that were initially reluctant to be vaccinated, vaccination policies contributed to strengthening pre-existing social inequalities around COVID-19 burden.

What Causes the Discrepancy in SARS-CoV-2 Vaccine Between Parental Hesitancy for Themselves and for Their Children During Lockdown Period?

BACKGROUND

Parents are usually the decision-makers for vaccinations of children. Therefore, it is important to understand parental beliefs and attitudes toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine for themselves and their children when it was approved for children age 3-17.

METHOD

A cross-sectional survey based on an anonymous online questionnaire for parents was conducted in seven provinces of China, and demographic information, vaccination history, parental decision motives, and health belief model toward themselves and their children were collected, respectively.

RESULTS

The overall parental hesitancy rate toward themselves was 20.30%, and that toward their children was 7.80%. More parental concerns on disease severity (odd ratio [OR] = 1.11, 95% confidence interval [CI]: 1.01-1.61) and susceptibility (OR = 1.29, 95% CI: 1.01-1.63) of children could be the causes of discrepancy in hesitancy for themselves and for their children. Parents who hesitated to vaccinate themselves might also be hesitated to vaccinate their children (β = 0.077, P < 0.001).

CONCLUSION

Threat perception may lead to inconsistencies in parental vaccination decisions toward themselves and toward their children. Correcting misinformation and strengthening education about COVID-19 are of great significance in addressing vaccine hesitancy among parents and children.

Exploring public sentiment and vaccination uptake of COVID-19 vaccines in England: a spatiotemporal and sociodemographic analysis of Twitter data

Objectives

Vaccination is widely regarded as the paramount approach for safeguarding individuals against the repercussions of COVID-19. Nonetheless, concerns surrounding the efficacy and potential adverse effects of these vaccines have become prevalent among the public. To date, there has been a paucity of research investigating public perceptions and the adoption of COVID-19 vaccines. Therefore, the present study endeavours to address this lacuna by undertaking a spatiotemporal analysis of sentiments towards vaccination and its uptake in England at the local authority level, while concurrently examining the sociodemographic attributes at the national level.

Methods

A sentiment analysis of Twitter data was undertaken to delineate the distribution of positive sentiments and their demographic correlates. Positive sentiments were categorized into clusters to streamline comparison across different age and gender demographics. The relationship between positive sentiment and vaccination uptake was evaluated using Spearman's correlation coefficient. Additionally, a bivariate analysis was carried out to further probe public sentiment towards COVID-19 vaccines and their local adoption rates.

Result

The results indicated that the majority of positive tweets were posted by males, although females expressed higher levels of positive sentiment. The age group over 40 dominated the positive tweets and exhibited the highest sentiment polarity. Additionally, vaccination uptake was positively correlated with the number of positive tweets and the age group at the local authority level.

Conclusion

Overall, public opinions on COVID-19 vaccines are predominantly positive. The number of individuals receiving vaccinations at the local authority level is positively correlated with the prevalence of positive attitudes towards vaccines, particularly among the population aged over 40. These findings suggest that targeted efforts to increase vaccination uptake among younger populations, particularly males, are necessary to achieve widespread vaccination coverage.

Hesitation about coronavirus vaccines in healthcare professionals and general population in Spain

BACKGROUND

This study attempts to provide a picture of the hesitancy to vaccination against COVID-19 in Spain during the 2021 spring-autumn vaccination campaign, both in the general population and in healthcare professionals.

METHODS

The participants were recruited using social media such as Facebook and Twitter, in addition to the cooperation of health personnel contacted with the collaboration of medical scientific societies. A cross-sectional study was carried out that included the response of an online questionnaire. The data were collected from April 30 to September 26, 2021. To assess the different associations between variables to be measured, we fit Poisson regression models with robust variance.

RESULTS

Responses were obtained from 3,850 adults from the general population group and 502 health professionals. Of the overall sample, 48.6% of participants from the general population were vaccinated against COVID-19, whereas in the healthcare professionals, 94.8% were vaccinated. The prevalence of general population vaccination increased with age, and was higher in women than men. Most participants did not show a preference for any vaccine itself. However, the prevalence of people vaccinated with their preferred vaccine was higher for the ones vaccinated with Pfizer's vaccine. 6.5% of the general population reported being reticent to be vaccinated. People from younger age groups, people with lower educational levels and those who were not from a risk group showed greater reluctance to be vaccinated. No gender differences in reluctancy were found.

CONCLUSIONS

Health professionals were significantly less likely to refuse vaccination even though they had more doubts about the safety and efficacy of vaccines. On the other hand, younger people, those with a lower level of education and those who were not from a risk group were the most hesitant.

Mapping global acceptance and uptake of COVID-19 vaccination: A systematic review and meta-analysis

Background

The COVID-19 pandemic exit strategies depend on widespread acceptance of COVID-19 vaccines. We aim to estimate the global acceptance and uptake of COVID-19 vaccination, and their variations across populations, countries, time, and sociodemographic subgroups.

Methods

We searched four peer-reviewed databases (PubMed, EMBASE, Web of Science, and EBSCO) for papers published in English from December 1, 2019 to February 27, 2022. This review included original survey studies which investigated acceptance or uptake of COVID-19 vaccination, and study quality was assessed using the Appraisal tool for Cross-Sectional Studies. We reported the pooled acceptance or uptake rates and 95% confidence interval (CI) using meta-analysis with a random-effects model.

Results

Among 15690 identified studies, 519 articles with 7,990,117 participants are eligible for meta-analysis. The global acceptance and uptake rate of COVID-19 vaccination are 67.8% (95% CI: 67.1–68.6) and 42.3% (95% CI: 38.2–46.5), respectively. Among all population groups, pregnant/breastfeeding women have the lowest acceptance (54.0%, 46.3–61.7) and uptake rates (7.3%, 1.7–12.8). The acceptance rate varies across countries, ranging from 35.9% (34.3–37.5) to 86.9% (81.4–92.5) for adults, and the lowest acceptance is found in Russia, Ghana, Jordan, Lebanon, and Syria (below 50%). The acceptance rate declines globally in 2020, then recovers from December 2020 to June 2021, and further drops in late 2021. Females, those aged < 60 years old, Black individuals, those with lower education or income have the lower acceptance than their counterparts. There are large gaps (around 20%) between acceptance and uptake rates for populations with low education or income.

Conclusion

COVID-19 vaccine acceptance needs to be improved globally. Continuous vaccine acceptance monitoring is necessary to inform public health decision making.

The Authorization of the First COVID-19 Vaccines Changed the Level and Nature of Intend to Get Vaccinated

Despite the abundance of literature on vaccine hesitancy, how public opinion changes during and after the authorization of a new vaccine remains an open question. The COVID-19 pandemic offers a unique case since the development and roll-out of the first generation of vaccines happened at unprecedented speed. To understand how the public's intent to get vaccinated changed around the emergency authorizations of the first COVID-19 vaccines, we ran a secondary analysis of survey data that consisted of rolling cross-sections of Facebook users in 23 countries (N = 375,627) between July 2020 and April 2021. In contrast to prior longitudinal work, we did not only investigate the change in levels of the intent to get vaccinated but also in the nature of it, i.e., the change in the influence of core predictors. Moreover, our data span a longer phase than prior work and included various countries in the Global South. We found that the intent to get vaccinated decreased around the time of the authorization of the first COVID-19 vaccines before it increased again. In the composition of people who refused vaccination or were undecided, notable differences were found for age, gender, and, most importantly, trust in health authorities as information sources before, around, and after the authorization of the vaccines. We conclude that the importance of trust-inducing communication in the early phase of a vaccination campaign cannot be overstated.

Changes in the public attitude toward childhood vaccine and the COVID-19 vaccine during different periods: A repeated cross-section study in Wuxi city, China

BACKGROUND

It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy towards routine childhood vaccination and hesitancy toward the coronavirus disease 2019 (COVID-19) vaccine during the ongoing COVID-19 pandemic.

OBJECTIVE

This study aimed to assess changes in trends of parental attitudes toward routine childhood vaccine and COVID-19 vaccinations across different time periods in China.

METHODS

Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness.

RESULTS

Overall, 2,881, 1,038, and 1,183 participants were included in the survey's three-waves. Using the Vaccine Hesitancy Scale, 7.8%, 15.1%, and 5.5% of parents showed hesitancy to children vaccination (P<.001), and 59.3%, 64.6%, and 92.0% of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, "concerns about vaccine safety and side effects" was the most common reason for refusal.

CONCLUSIONS

There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions need be taken to mitigate public concerns about vaccine safety.

CLINICALTRIAL

Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies

Ethnic minority communities in the UK have been disproportionately affected by the pandemic, with increased risks of infection, severe disease, and death. Hesitancy around the COVID-19 vaccine may be contributing to disparities in vaccine delivery to ethnic minority communities. This systematic review aims to strengthen understanding of COVID-19 vaccine concerns among ethnic minorities in the UK. Five databases were searched in February 2022, yielding 24 peer-reviewed studies reporting on vaccine hesitancy or acceptance in ethnic minority groups. Data were extracted using a standardised form, and quality assessment was carried out using the Standard Quality Criteria. There were three key themes: (1). Prevalence of vaccine hesitancy; (2). Reasons for vaccine hesitancy and acceptance; and (3). Recommendations to address vaccine concerns. Vaccine hesitancy, which was more common among some ethnic minority groups, is a complex phenomenon, driven by misinformation, mistrust, concerns about safety and efficacy, and structural and systemic inequities. Community engagement and tailored communication may help to address vaccine concerns. Robust data disaggregated by ethnicities are needed to better understand barriers and facilitators for COVID-19 vaccine delivery in ethnic minority communities. Strategies to address structural disadvantage need to be inclusive, comprehensive, and behaviorally informed and foster confidence in healthcare systems and governments. Community leaders and health care practitioners may prove to be the most important agents in creating an environment of trust within ethnic minority groups.

The social gradient in COVID-19 vaccination intentions and the role of solidarity beliefs among adolescents

BACKGROUND

Vaccines against COVID-19 play a prominent role in the policies enacted to combat the pandemic. However, vaccination rates are lowest among adolescents and young adults. Therefore, research on younger individuals is needed to provide a deeper understanding of social disparities and the motives behind vaccination intentions.

METHODS

This study draws on a sample (N = 4079) of German high school students and graduates. Based on cross-sectional data from March to July 2021 and linear regression models, which are conditioned on personality, risk preferences, and trust, the study analyses social disparities (i.e., gender, parental education and migration background) in vaccination intentions.

RESULTS

We do not find heterogeneity by gender. Individuals with low-educated parents and a migration background indicate below-average levels of vaccination intention. Differences in solidarity beliefs entirely explain the heterogeneity between individuals with low-educated parents and those with high-educated parents. While differences in beliefs explain a substantial part of the heterogeneity in vaccination intentions, cultural and monetary resources also constitute an important source of difference in vaccination intentions between individuals with and without a migration background. These results are important because our data indicate higher infection risks among individuals with a migration and low education background. Additionally, individuals from lower social origins and with migration backgrounds report higher levels of perceived burdens associated with COVID-19-related policies. The migration results differ between first- and second-generation migrants and by region of origin.

CONCLUSION

Polarization in solidarity explains social gradients in vaccination intention. A solidarity narrative may not motivate a significant share of young individuals to be vaccinated.

Factors Associated with COVID-19 Vaccine Hesitancy after Implementation of a Mass Vaccination Campaign

An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September-November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, "COVID-19 Barometer: Social Opinion". Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.

The social specificities of hostility toward vaccination against Covid-19 in France

Equal Access to the COVID-19 vaccine for all remains a major public health issue. The current study compared the prevalence of vaccination reluctance in general and COVID-19 vaccine hesitancy and social and health factors associated with intentions to receive the vaccine. A random socio-epidemiological population-based survey was conducted in France in November 2020, in which 85,855 adults participants were included in this study. We used logistic regressions to study being "not at all in favor" to vaccination in general, and being "certainly not" willing to get vaccinated against Covid-19. Our analysis highlighted a gendered reluctance toward vaccination in general but even more so regarding vaccination against COVID-19 (OR = 1.88 (95% CI: 1.79-1.97)). We also found that people at the bottom of the social hierarchy, in terms of level of education, financial resources, were more likely to refuse the COVID-19 vaccine (from OR = 1.22 (95% CI:1.10-1.35) for respondents without diploma to OR = 0.52 (95% CI:0.47-0.57) for High school +5 or more years level). People from the French overseas departments, immigrants and descendants of immigrants, were all more reluctant to the Covid-19 vaccine (first-generation Africa/Asia immigrants OR = 1.16 (95% CI:1.04-1.30)) versus OR = 2.19 (95% CI:1.96-2.43) for the majority population). Finally, our analysis showed that those who reported not trusting the government were more likely to be Covid-19 vaccine-reluctant (OR = 3.29 (95% CI: 3.13-3.45)). Specific campaigns should be thought beforehand to reach women and people at the bottom of the social hierarchy to avoid furthering social inequalities in terms of morbidity and mortality.