It is time to get serious about vaccine confidence

Factors Influencing COVID-19 Vaccine Confidence and Uptake in Australian Adults

In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia.

Predictors of Intention to Vaccinate or Continue to Vaccinate Children Against SARS-CoV-2 During the Fifth Wave of the COVID-19 Pandemic in the USA

The Centre for Disease Control recommends vaccination of children against SARS-CoV-2 to reduce the severity of COVID-19 disease and reduce the likelihood of associated complications. Vaccination of children requires the consent of parents or guardians, and levels of consent may ebb and flow over the course of the pandemic. This exploratory study examines predictors of parental intentions to vaccinate their children and the speed with which they would have them vaccinated during the fifth wave of the pandemic when vaccines were just being approved for use in children using a convenience sample of 641 parents reporting on 962 children. Multi-level regression analyses demonstrated regional differences in likelihood, with those in the Northeast reporting higher likelihood than those in the West. Parents with a conservative belief system were less likely to want to have their children vaccinated. Parents were more likely to have their child vaccinated if the child had COVID-19-related health risks, their child had a more complete vaccination history, and COVID-19 was perceived to be a greater threat to oneself and one's family. Faster intended vaccination speed was associated with regional urbanicity, liberal belief systems, more complete vaccination histories, and parental COVID-19 vaccination history. Higher levels of parental anxiety and lower levels of perceived vaccine danger were associated with increased speed. The severity of the COVID-19 pandemic within one's county was marginally related to speed, but not likelihood. These results underscore the importance of regular assessment of parental intentions across the pandemic, for practitioners to probe parental anxiety levels when discussing vaccination, to explicitly address risk/benefit analyses when communicating with parents, and to target previously routine unvaccinated parents and those in more rural areas to increase vaccine uptake. Comparisons are made with Galanis et al.'s (2022) recent meta-analysis on the topic.

Compliance, procrastination and refusal: American COVID-19 vaccination trust and value orientation

INTRODUCTION

COVID-19 vaccine hesitancy studies, most of which were completed prior to the release of the vaccine, speculated on factors that might influence inoculation intention when a vaccine was introduced. This paper examines actual vaccination decisions among US residents after COVID-19 vaccines were approved, with a focus on trust in vaccine effectiveness, increased trust in government pandemic response, and individual-versus-collective value orientation.

METHOD

The data set was from the Kaiser Family Foundation COVID-19 Vaccine Monitor, a nationally representative sample reflecting the opinions of 1519 American adults aged 18 and above. Data were collected in September 2021-approximately nine months after the first COVID-19 vaccines were approved for distribution. Indicators of trust in vaccine effectiveness included individual opinions regarding breakthrough infections and vaccine boosters. Increased trust in government indicated approval of official COVID-19 responses, and value orientation denoted respondent emphasis on personal choice versus protecting the health of others. We established three categories of a vaccine hesitancy dependent variable: none, some, and full rejection. A multinomial regression analysis was employed to compare vaccine hesitancy in three pairs of contrasting groups.

RESULTS

While we noted distinct patterns in decision-making factors for each of the contrasting pairs, we also observed strong effects for trust in vaccine effectiveness and value orientation on vaccine decisions across all three. Both effects were more substantial than those associated with three control variables-social-demographic characteristics, political party affiliation, and health risk.

CONCLUSION

Our findings suggest that in order to increase vaccination rates, policymakers and influencers should focus on reducing individual scepticism over breakthrough infections and vaccine boosters, and on influencing a value orientation shift from personal choice to social responsibility.

Estimating the size of "anti-vax" and vaccine hesitant populations in the US, UK, and Canada: comparative latent class modeling of vaccine attitudes

Vaccine hesitancy is a significant impediment to global efforts to vaccinate against the SARS-CoV-2 virus at levels that generate herd immunity. In this article, we show the utility of an inductive approach - latent class analysis (LCA) - that allows us to characterize the size and nature of different vaccine attitude groups; and to compare how these groups differ across countries as well as across demographic subgroups within countries. We perform this analysis using original survey data collected in the US, UK, and Canada. We also show that these classes are strongly associated with SARS-CoV-2 vaccination intent and perceptions of the efficacy and safety of the COVID-19 vaccines, suggesting that attitudes about vaccines to fight the novel coronavirus pandemic are well explained by latent vaccine attitudes that precede the pandemic. More specifically, we find four substantive classes of vaccine attitudes: strong supporters, supporters with concerns, vaccine hesitant, and "anti-vax" as well as a fifth measurement error class. The strong "anti-vax" sentiment class is small in all three countries, while the strong supporter class is the largest across all three countries. We observe different distributions of class assignments in different demographic groups - most notably education and political leaning (partisanship and ideology).

Influence of Information Sources on Chinese Parents Regarding COVID-19 Vaccination for Children: An Online Survey

(1) Aims: This study explored the mechanism by which exposure to different information sources on social media influences Chinese parents' intention to vaccinate their children against COVID-19. (2) Methods: We developed a research framework based on the Stimulus-Organism-Response (SOR) theory to illustrate how exposure to information sources on social media increases vaccine confidence and, as a result, parents' intentions regarding pediatric vaccination. The partial least square structural equation modeling (PLS-SEM) method was used to test the data collected through an online survey (687 valid samples). (3) Results: The government approval of vaccines fuels vaccination confidence and acts as a mediator between (a) mass media, government new media, and key opinion leaders, and (b) perceived effectiveness and side effects (safety) of vaccines. (4) Conclusions: The mass media, government new media, and key opinion leaders are crucial sources for encouraging parents to vaccinate their children since they boost the vaccination trust. The focus of COVID-19 vaccination promotion should be to strengthen parents' trust in the government, combined with publicizing the effectiveness and side effects (safety) of vaccines.

Efficacy information influences intention to take COVID-19 vaccine

OBJECTIVES

A successful response to the COVID-19 pandemic requires achieving high levels of vaccine uptake. We tested whether directly contrasting the high efficacy of COVID-19 vaccines with the lower efficacy of the annual flu vaccine would increase intentions to take a COVID-19 vaccine.

DESIGN

A pre-registered online study of 481 participants compared four information conditions: (1) no information; (2) COVID-19 Vaccine Information Only; and COVID-19 Vaccine Information combined with flu vaccine information suggesting either (3) 60% efficacy or (4) 40% efficacy; we measured COVID-19 and flu vaccine intentions along with several other vaccine-related variables.

METHODS

The Prolific platform was used to recruit 481 UK participants (64% female; aged between 18 and 85 years) who had been pre-screened to have intermediate levels of vaccine hesitancy. After reading a short text (~200 words) about COVID-19 vaccines, participants were asked about their vaccination intentions.

RESULTS

Providing information about the safety and efficacy of the new COVID-19 vaccines resulted in vaccination intentions that were, on average, 0.39 standard deviations (SDs) higher than those in the no information condition; providing the same COVID vaccine efficacy information in the context of information about flu vaccine efficacy resulted in a further significant increase in vaccination intentions that were 0.68 SD higher than those in the no information condition. This positive contrast effect for the COVID-19 vaccine was not associated with reduced flu vaccine intentions.

CONCLUSIONS

Vaccination intentions can be strengthened through a simple messaging intervention that utilizes context effects to increase perceived response efficacy.

Communications to Promote Interest and Confidence in COVID-19 Vaccines

PURPOSE

Communicating about COVID-19 vaccine side effects and efficacy is crucial for promoting transparency and informed decision-making, but there is limited evidence on how to do so effectively.

DESIGN

A within-subjects experiment.

SETTING

Online survey from January 21 to February 6, 2021.

SUBJECTS

596 US Veterans and 447 non-Veterans.

INTERVENTION

5 messages about COVID-19 vaccine side effects and 4 messages about COVID-19 vaccine efficacy.

MEASURES

COVID-19 vaccine interest (1 = "I definitely do NOT want the vaccine" to 7 = "I definitely WANT the vaccine" with the midpoint 4 = "Unsure"). Confidence about COVID-19 vaccine efficacy (1= "Not at all confident," 2 = "Slightly confident," 3 = "Somewhat confident," 4 = "Moderately confident," 5 = "Extremely confident").

RESULTS

Compared to providing information about side effects alone (M = 5.62 [1.87]), messages with additional information on the benefits of vaccination (M = 5.77 [1.82], P < .001, d_z = .25), reframing the likelihood of side effects (M = 5.74 [1.84], P < .001, d_z = .23), and emphasizing that post-vaccine symptoms indicate the vaccine is working (M = 5.72 [1.84], P < .001, d_z = .17) increased vaccine interest. Compared to a vaccine efficacy message containing verbal uncertainty and an efficacy range (M = 3.97 [1.25]), messages conveying verbal certainty with an efficacy range (M = 4.00 [1.24], P = .042, d_z=.08), verbal uncertainty focused on the upper efficacy limit (M = 4.03 [1.26], P < .001, d_z = .13), and communicating the point estimate with certainty (M = 4.02 [1.25], P < .001, d_z = .11) increased confidence. Overall, Veteran respondents were more interested (M_Veterans = 5.87 [1.72] vs M_NonVeterans = 5.45 [2.00], P < .001, d = .22) and confident (M_Veterans = 4.13 [1.19] vs M_NonVeterans = 3.84 [1.32], P < .001, d = .23) about COVID-19 vaccines than non-Veterans.

CONCLUSIONS

These strategies can be implemented in large-scale communications (e.g., webpages, social media, and leaflets/posters) and can help guide healthcare professionals when discussing vaccinations in clinics to promote interest and confidence in COVID-19 vaccines.

Animated, video entertainment-education to improve vaccine confidence globally during the COVID-19 pandemic: an online randomized controlled experiment with 24,000 participants

Background

Science-driven storytelling and entertainment-education (E-E) media demonstrate potential for promoting improved attitudes and behavioral intent towards health-related practices. Months after the outbreak of coronavirus disease 2019 (COVID-19), emerging research highlights the essential role of interventions to improve public confidence in the COVID-19 vaccine. To improve vaccine confidence, we designed three short, animated videos employing three research-informed pedagogical strategies. These can be distributed globally through social media platforms, because of their wordless and culturally accessible design. However, the effectiveness of short, animated storytelling videos, deploying various pedagogic strategies, needs to be explored across different global regions.

Methods/design

The present study is a multi-site, parallel group, randomized controlled trial (RCT) comparing the effectiveness of (i) a storytelling-instructional-humor approach, (ii) a storytelling-analogy approach, (iii) a storytelling-emotion-focused approach, and (iv) no video. For our primary outcomes, we will measure vaccine hesitancy, and for secondary outcomes, we will measure behavioral intent to seek vaccination and hope. Using online platforms, we will recruit 12,000 participants (aged 18–59 years) from the USA and China, respectively, yielding a total sample size of 24,000.

Discussion

This trial uses innovative online technology, reliable randomization algorithms, validated survey instruments, and list experiments to establish the effectiveness of three short, animated videos employing various research-informed pedagogical strategies. Results will be used to scientifically support the broader distribution of these short, animated video as well as informing the design of future videos for rapid, global public health communication.

Trial registration

German Clinical Trials Register DRKS #00023650. Date of registration: 2021/02/09.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06067-5.

Prevalence, Knowledge and Potential Determinants of COVID-19 Vaccine Acceptability Among University Students in the United Arab Emirates: Findings and Implications

Objective

To evaluate the prevalence, knowledge, attitude and acceptance of the COVID-19 vaccines and related factors among university students in the United Arab Emirates.

Methods

Analytical cross-sectional study undertaken among a convenient sample of medical and non-medical colleges of Ajman University using a self-administrated questionnaire. The questionnaire included demographic data as well as assessing knowledge of COVID-19, attitudes and acceptance of COVID-19 vaccines.

Results

A total of 467 students participated in the study and completed the questionnaire. A total of 181 (38.8%) participants reported that they have been vaccinated against COVID-19 virus, principally with the Sinopharm vaccine (84%). Vaccination against the COVID-19 virus was less prevalent among Arabic nationalities compared to other nationalities, but more prevalent among students from health science colleges compared to those from non-health science colleges. The acceptance rate of COVID-19 vaccine among study participants was 56.3%, exacerbated by worries regarding unforeseen problems (65.5%, 306), general mistrust (47.3%, 221) and unforeseen impacts (35.1%, 164). The average knowledge score was 60.1%, with 142 (30.4%) having poor knowledge, 127 (27.2%) acceptable knowledge and 198 (42.4%) good knowledge. There were common misconceptions about symptoms including nausea and diarrhoea, as well as the route of transmission, with half believing antibiotics are effective treatment.

Conclusion

There was variable knowledge of COVID-19 among students. Misconceptions need addressing going forward. To enhance COVID-19 vaccination uptake in the country and worldwide, health education targeting diverse sociodemographic categories should be prioritized.

Unique Predictors of Intended Uptake of a COVID-19 Vaccine in Adults Living in a Rural College Town in the United States

PURPOSE

To explore public confidence in a COVID-19 vaccine.

DESIGN

Cross-sectional survey.

SETTING

A rural college town in central Pennsylvania.

SUBJECTS

Adult residents without minor children.

MEASURES

The primary outcome was COVID-19 vaccination intention. Secondary measures included vaccination attitudes, norms, efficacy, past behavior, trust in the vaccination process, and sociodemographic variables of education, financial standing, political viewpoint, and religiosity.

ANALYSIS

Descriptive statistics were used to describe quantitative data. Multivariate ordinal regression was used to model predictors of vaccine intention.

RESULTS

Of 950 respondents, 55% were "very likely" and 20% "somewhat likely" to take a coronavirus vaccine, even though 70% had taken the flu vaccine since September 2019. The strongest predictors of vaccine acceptance were trust in the system evaluating vaccines and perceptions of local COVID-19 vaccination norms. The strongest predictors of negative vaccine intentions were worries about unknown side-effects and positive attitudes toward natural infection. Sociodemographic factors, political views, and religiosity did not predict vaccine intentions.

CONCLUSION

Fewer adults intend to take a coronavirus vaccine than currently take the flu vaccine. Traditional sociodemographic factors may not be effective predictors of COVID-19 vaccine uptake. Although based on a small sample, the study adds to our limited understanding of COVID-19-specific vaccine confidence among some rural Americans and suggests that traditional public health vaccination campaigns based on sociodemographic characteristics may not be effective.

SARS-CoV-2 mRNA Vaccine Attitudes as Expressed in U.S. FDA Public Commentary: Need for a Public-Private Partnership in a Learning Immunization System

As part of the U.S. Food and Drug Administration COVID-19 vaccine review process, public commentary was solicited offering an opportunity to reflect on vaccine attitudes that may impact the uptake of coronavirus vaccines. We identified themes in the commentary that highlighted the safety, efficacy, ethics, and trustworthiness and transparency regarding the novel mRNA COVID-19 vaccines. A “Learning Immunization System” model is proposed to optimize public, private, and academic partnerships relating to vaccine development and implementation.

Potential impact of introducing vaccines against COVID-19 under supply and uptake constraints in France: A modelling study

BACKGROUND

The accelerated vaccine development in response to the COVID-19 pandemic should lead to a vaccine being available early 2021, albeit in limited supply and possibly without full vaccine acceptance. We assessed the short-term impact of a COVID-19 immunization program with varying constraints on population health and non-pharmaceutical interventions (NPIs) needs.

METHODS

A SARS-CoV-2 transmission model was calibrated to French epidemiological data. We defined several vaccine implementation scenarios starting in January 2021 based on timing of discontinuation of NPIs, supply and uptake constraints, and their relaxation. We assessed the number of COVID-19 hospitalizations averted, the need for and number of days with NPIs in place over the 2021-2022 period.

RESULTS

An immunisation program under constraints could reduce the burden of COVID-19 hospitalizations by 9-40% if the vaccine prevents against infections. Relaxation of constraints not only reduces further COVID-19 hospitalizations (30-39% incremental reduction), it also allows for NPIs to be discontinued post-2021 (0 days with NPIs in 2022 versus 11 to 125 days for vaccination programs under constraints and 327 in the absence of vaccination).

CONCLUSION

For 2021, COVID-19 control is expected to rely on a combination of NPIs and the outcome of early immunisation programs. The ability to overcome supply and uptake constraints will help prevent the need for further NPIs post-2021. As the programs expand, efficiency assessments will be needed to ensure optimisation of control policies post-emergency use.