Uncoupling vaccination from politics: a call to action

Investigating the Relation of Political Orientation and Vaccination Outcomes: Identifying the Roles of Political Ideology, Party Affiliation, and Vaccine Hesitancy

Popular press and academic articles alike suggest that political orientation is a primary determinant of vaccination willingness, vaccination, and vaccine word-of-mouth (i.e., sharing of information regarding vaccines). In the current article, we test the validity of these suggestions, and we also assess the differential roles of political ideology (e.g., liberal-conservative) and party affiliation (e.g., Democrat-Republican) as well as the mediating effect of vaccine hesitancy's dimensions. To do so, we perform a four-wave survey study with 223 participants that completed all waves. Our results support that political orientation indeed relates to our outcomes of interest. Our results also show that political ideology has a more pronounced effect than party affiliation, and the vaccine hesitancy dimensions of Health Risks and Healthy mediate many of these relations. From these results, we suggest many directions for future research and practice, including the integration of political discourse theories in studies on political orientations and vaccination.

Public Attitudes, Inequities, and Polarization in the Launch of the 988 Lifeline

CONTEXT

To address the considerable burden of mental health need in the United States, Congress passed the National Suicide Hotline Designation Act in 2020. The act rebranded the national suicide prevention lifeline as 988, a three-digit number akin to 911 for individuals to call in the case of a mental health emergency. Surprisingly little is known about American attitudes toward this new lifeline.

METHODS

The authors use a demographically representative survey of 5,482 US adults conducted June 24-28, 2022, to examine the influence of mental health status, partisan identification, and demographic characteristics on public awareness of the new 988 lifeline, public support for the lifeline, and intention to use it.

FINDINGS

The authors find that while only a quarter of Americans are aware of the lifeline, support for the 988 lifeline is widespread, with more than 75% of Americans indicating they would be likely to use the new number if needed. The authors identify key disparities in awareness, support, and intended use, with Republicans, individuals with low socioeconomic status, and Blacks less supportive of the 988 lifeline and in some cases less likely to use it.

CONCLUSIONS

The results point to the need for additional interventions that increase public awareness of 988 and reduce disparities in program knowledge, support, and intention to use.

Vaccine Confidence as Critical to Pandemic Preparedness and Response

Vaccine confidence is a belief that vaccines work, are safe, and are part of a trustworthy medical system. The COVID-19 pandemic exposed the fragility of the public's confidence in vaccines and the vaccine enterprise, limiting the public health impact of vaccination. In this review, we examine the critical nature of vaccine confidence to pandemic preparedness and response.

California's COVID-19 Vaccine Equity Policy: Cases, Hospitalizations, And Deaths Averted In Affected Communities

In March 2021, California implemented a vaccine equity policy that prioritized COVID-19 vaccine allocation to communities identified as least advantaged by an area-based socioeconomic measure, the Healthy Places Index. We conducted quasi-experimental and counterfactual analyses to estimate the effect of this policy on COVID-19 vaccination, case, hospitalization, and death rates. Among prioritized communities, vaccination rates increased 28.4 percent after policy implementation. Furthermore, an estimated 160,892 COVID-19 cases, 10,248 hospitalizations, and 679 deaths in the least-advantaged communities were averted by the policy. Despite these improvements, the share of COVID-19 cases, hospitalizations, and deaths in prioritized communities remained elevated. These estimates were robust in sensitivity analyses that tested exchangeability between prioritized communities and those not prioritized by the policy; model specifications; and potential temporal confounders, including prior infections. Correcting for disparities by strategically allocating limited resources to the least-advantaged or most-affected communities can reduce the impacts of COVID-19 and other diseases but might not eliminate health disparities.

Developing interfaith interventions to address hesitancy towards COVID-19 vaccination: protocol for a focus group-based, exploratory qualitative study

INTRODUCTION

The COVID-19 pandemic demonstrated how vaccine hesitancy impacts are translated nationally and internationally. A predictor of vaccine hesitancy is religious beliefs (eg, the body being sacred and should be healed by God). Additionally, the perceived content of vaccines can conflict with religious dietary restrictions. Despite the main faith organisations in the UK endorsing COVID-19 vaccination, vaccine hesitancy remains a challenge. Most faith-based research and interventions have been investigated in individual faiths, in isolation from others. Therefore, the aim of our research is to inform the development of interfaith interventions to address COVID-19 vaccine hesitancy, following the identification of potential facilitators and barriers and codesign of interfaith intervention(s).

METHODS AND ANALYSIS

We will facilitate six face-to-face focus groups in London, each comprising eight participants. There will also be the option of joining an online focus group. A semistructured topic guide will include questions on experiences around interfaith, vaccine hesitancy, facilitators and barriers, and potential interfaith interventions to increase vaccine acceptance. Focus group participants will be invited to join a subsequent interfaith codesign workshop where the researchers will share the tentative findings and facilitate discussion to develop one or more interventions. Purposive sampling will be used to recruit 48 participants from different faith groups, ethnicities and backgrounds to capture diversity in the sample. Reflexive thematic analysis will guide a systematic process of constant comparison, coding data into categories and refining into overarching themes.

ETHICS AND DISSEMINATION

The University College London (UCL) Research Ethics Committee granted ethics approval (Project ID 4359.006) on 3 May 2022. Minor amendments to the study were approved on 15 May 2023 to accommodate participants' requests for online or face-to-face focus groups at a UCL venue. Informed consent is required from all participants. The findings will be disseminated in journals and to the public and key stakeholders.

Sentiment analysis of the COVID-19 vaccine perception

The sharp rise in coronavirus cases in the United States, as well as other countries, is driven by variants such as the Omicron substrain, BA4 and BA5. Keeping up to date with COVID-19 vaccination and wearing masks are essential tools for mitigating the pandemic. Social media plays a vital role in sharing and exchanging information, but it also affects perceptions of social phenomena. In this study, we conducted sentiment analysis and topic modeling to investigate vaccine perception using 338,465 COVID-19 vaccine-related comments collected from January 2020 to May 2021 on Reddit. This study stands apart from prior COVID-related research on social media, particularly on Reddit, as it conducted separate analyses for each COVID vaccine and examines public sentiment with various societal events, including vaccine development progress and government responses to COVID. The findings reveal two notable spikes in the number of comments containing the keyword "vaccine". This suggests that discussions about vaccines tend to increase during times of significant social and political events, indicating that people's attention and interest in the topic are influenced by current events. Understanding the public perception of vaccines and identifying factors influencing vaccine perception could help propose appropriate interventions to promote vaccination.

"The CDC Won't Let Me Be": The Opinion Dynamics of Support for CDC Regulatory Authority

CONTEXT

The CDC's ability to respond to communicable disease threats has recently met significant political and legal opposition. The authors unpack the influence of political ideology on support for CDC authority, and they experimentally assess whether highlighting ideology's role in responding to health threats might bolster CDC support.

METHODS

The authors fielded a demographically representative online survey experiment to 5,483 US adults. They assessed the sociopolitical correlates of CDC attitudes via multivariate regression analyses limited to a study-wide treatment group. Additionally, they tested the effectiveness of their experimental treatments via multivariate models that interact indicators of stimulus exposure with political ideology.

FINDINGS

Although most Americans support the CDC's role in responding to health crises, self-identified conservatives are significantly less likely to do so. This effect holds when accounting for respondents' limited government and anti-expert attitudes, which the authors replicated in nationally representative data. Encouragingly, though, emphasizing the CDC's role in combating the spread of COVID-19 is associated with significantly stronger levels of support on the ideological right.

CONCLUSIONS

Efforts to communicate the CDC's importance in responding to health threats can help bridge existing ideological divides and might create an incentive for policy makers to codify the agency's regulatory powers.

Vaccine Preventable Disease and Vaccine Hesitancy

Global immunization programs have saved tens of millions of lives over the last 2 decades. Now, the recent successes of COVID-19 vaccines having saved more than 3 million lives in North America during the pandemic may open the door to accelerate technologies for other emerging infection vaccines. New vaccines for respiratory syncytial virus, norovirus, influenza, herpes simplex virus, shingles, dengue fever, enteric bacterial infections, malaria, and Chagas disease are advancing through clinical development and could become ready for delivery over the next 5 years. The successful delivery of these new vaccines may require expanded advocacy and communications efforts.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy.

METHOD

We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data.

SETTING

The survey was administered online using the survey research firm Dynata.

RESULTS

Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant.

CONCLUSIONS

Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

Vaccination and Voting Patterns in the U.S.: Analysis of COVID-19 and Flu Surveys From 2010 to 2022

INTRODUCTION

The study assessed the relationship between COVID-19 and influenza (flu) vaccination and voting patterns during the pandemic and the time trends between flu vaccination and voting patterns.

METHODS

Flu and COVID-19 vaccination coverage were analyzed using National Immunization Surveys for flu (Years 2010-2022) and COVID-19 (National Immunization Surveys Adult COVID-19 Module 2021-2022), Centers for Disease Control and Prevention surveillance of COVID-19 vaccination coverage (2021-2022) and U.S. COVID-19 Trends and Impact Survey (2021-2022). The study described the correlations between state-level COVID-19 and flu vaccination coverage, examined individual-level characteristics of vaccination for COVID-19 and for flu using logistic regression (COVID-19 Trends and Impact Survey May-June 2022), and analyzed flu vaccination coverage by age (National Immunization Surveys for flu 2010-2022) and its relationship with voting patterns.

RESULTS

There was a strong correlation between state-level COVID-19 vaccination coverage and voting share for the Democratic candidate in the 2020 presidential elections. COVID-19 vaccination coverage in June 2022 was higher than flu vaccination coverage, and it had a stronger correlation with voting patterns (R=0.90 vs R=0.60 in COVID-19 Trends and Impact Survey). Vaccinated people were more likely to be living in a county where the majority voted for the Democratic candidate in 2020 elections both for COVID-19 (adjusted OR=1.77, 95% CI=1.71, 1.84) and for flu (adjusted OR=1.27, 95% CI=1.23, 1.31). There is a longstanding correlation between voting patterns and flu vaccination coverage, which varies by age, with the strongest correlation in the youngest ages.

CONCLUSIONS

There are existing prepandemic patterns between vaccination coverage and voting patterns. The findings align with research that has identified an association between adverse health outcomes and the political environment in the U.S.

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.

Professional ethics for infectious disease control: moral conflict management in modern public health practice

OBJECTIVES

Despite scientific evidence that confirms their effectiveness, use of vaccines and microbiological mass testing during the COVID-19 pandemic has been associated with social and moral controversies. In this commentary, it is suggested how such conflicts originating from moral/normative imperatives can be managed in infectious disease control.

STUDY DESIGN

This was a commentary analysis.

METHODS

A case example of scientific and public debate regarding infectious disease control and policy-making during the early pandemic response is first presented. The case is used to characterize how conflicts arising from moral constraints occurred during the COVID-19 pandemic. These features are thereafter used as a basis for outlining a strategy for moral conflict prevention and management.

RESULTS

A challenge for infectious disease control throughout the pandemic was how to manage persuasive initiatives originating from social forces competing with science for influence. Purposively maneuvered information distributed through social media and internet websites could predispose population factions to contest legitimate (evidence and legally based) pandemic response measures. During the pandemic, fact-based criticism of professionals responsible for infectious disease control was mixed with a critique of their moral standards and intentions so as to diminish effectiveness and credibility. Such blending could be curtailed if infectious disease control professionals are made accountable for public health decisions made in the light of prevalent scientific evidence and legislation.

CONCLUSIONS

If the infectious disease control community would embrace the international code of medical professional ethics, this would help to deal with moral conflicts, especially ones arising from external threats, in modern public health.

Political orientation predicts the use of conventional and complementary/alternative medicine: A survey study of 19 European countries

BACKGROUND

People align their beliefs and behaviors, including those related to health, increasingly along politically ideological lines.

OBJECTIVE

We investigated whether individual political orientation (PO) predicts the use of conventional (CM) and complementary/alternative medicine (CAM) across Europe.

METHODS

We used cross-sectional samples representative of persons aged 15 and over from 19 European countries (ESS 2015; round 7; N = 35,572). We assessed PO based on participants' vote choice in the most recent national election, using expert ratings of party positioning along five political-ideological dimensions: left-right general; left-right economic; Green/alternative/libertarian vs. Traditional/authoritarian/nationalist; anti-elite; and anti-corruption. Use of CM was defined as having consulted a general practitioner or specialist, and use of CAM as having used acupuncture, acupressure, Chinese medicine, homeopathy, herbal treatment, hypnotherapy, or spiritual healing.

RESULTS

Participants with an anti-corruption PO were less likely to use CM and more likely to use CAM than other Europeans. Participants with a Green/alternative/libertarian PO were more likely to use CAM than others. Poorer health moderated the association between anti-corruption PO and CM, such that people in poor health tended to use CM regardless of their political leanings, but health status did not moderate the association between PO and CAM use.

CONCLUSIONS

The results show that political and socio-cultural views are associated with how the European lay public engages with healthcare and complementary/alternative services, but the relevant boundary lines do not lie along the left-right dimension. People who preferred parties favoring expanded freedoms were more likely to use complementary/alternative services, but likely for other reasons than to seek cures for diseases in a traditional biomedical sense. Concerns about corruption among the lay public may be more relevant for conventional healthcare than has been recognized.

The Moral Foundations of Vaccine Passports

The debate around vaccine passports has been polarising and controversial. Although the measure allows businesses to resume in-person operations and enables transitioning out of lockdown due to the COVID-19 pandemic, some have expressed concerns about liberty violations and discrimination. Understanding the splintered viewpoints can aid businesses in communicating such measures to employees and consumers. We conceptualise the business implementation of vaccine passports as a moral decision rooted in individual values that influence reasoning and emotional reaction. We surveyed support for vaccine passports on a nationally representative sample in the United Kingdom in 2021: April (n = 349), May (n = 328), and July (n = 311). Drawing on the Moral Foundations Theory-binding (loyalty, authority, and sanctity), individualising (fairness and harm), and liberty values-we find that individualising values are a positive predictor and liberty values a negative predictor of support for passports, suggesting adoption hinges on addressing liberty concerns. Longitudinal analysis examining the trajectory of change in support over time finds that individualising foundations positively predict changes in utilitarian and deontological reasoning over time. In contrast, a fall in anger over time predicts increased support towards vaccine passports. Our study can inform business and policy communication strategies of existing vaccine passports, general vaccine mandates, and similar measures in future pandemics.

The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.

Erroneous Consonance. How inaccurate beliefs about physician opinion influence COVID-19 vaccine hesitancy

Throughout the COVID-19 pandemic, researchers have studied how Americans' attitudes toward health experts influence their health behaviors and policy opinions. Fewer, however, consider the potential gap between individual and expert opinion about COVID-19, and how that might shape health attitudes and behavior. This omission is notable, as discrepancies between individual and expert opinion could help explain why some Americans fail to take action to protect themselves and others from the virus. In novel demographically representative surveys of the US adult population (N = 5,482) and primary care physician subpopulations (PCPs; N = 625), we contrast the relationship between: (1) Americans' and (2) PCPs' preferences regarding who ought to be responsible for taking action to combat the spread of COVID-19, as well as (3) Americans' perceptions of PCP preferences ("PCP meta-opinion"). In the aggregate, we find that Americans are far less likely than PCPs to see a role for both private and state actors in taking action to combat COVID-19. Interestingly, though, this disjuncture is not reflected in individual-level PCP meta-opinion; as most Americans think that PCPs share their views on state and private intervention (τ_b = 0.44-0.49). However, this consonance is often erroneous, which we show can have problematic health consequences. Multivariate models suggest that Americans who both see little place for individual responsibility in taking action to stop viral spread and who think that PCPs share those views are significantly less likely to vaccinate against COVID-19. We conclude by discussing the public health benefits of efforts to bring public opinion in line with expert opinion.

Left-Right-Position, party affiliation and regional differences explain low COVID-19 vaccination rates in Germany

Established vaccine hesitancy measurement instruments, such as the Vaccine Hesitancy Determinants Matrix, are not sufficiently equipped to adequately and consistently measure political and ideological attitudes. Focusing on Germany, which is a particularly interesting case since it witnessed the establishment of the by far most well-organized and sustained 'anti-Covid' movement in Europe, this quantitative study explores the impact of political ideology and partisanship on the degree of vaccine hesitancy based on four surveys (February-October 2021) among more than 30,000 individuals. We demonstrate that party affiliation, political ideology and region of residence all impact vaccine hesitancy. In fact, they turn out to have a greater impact than two factors often analysed with respect to vaccine hesitancy: gender and educational background. Further interaction models show that the effect of political ideology on vaccine hesitancy is moderated by age, gender and region of residency. For instance, while the more rightwing a young individual is, the more hesitant they are towards SARS-CoV-2 vaccination-for older individuals, this is not the case. Our findings are relevant for future investigators measuring vaccine hesitancy and policy makers contemplating the differential impact of complex public health interventions: as the impact of political and ideological attitudes on vaccine hesitancy are not adequately captured by established vaccine hesitancy measurement instruments, we recommend its modification to include a clear and harmonised definition of the political-ideological dimension of vaccine hesitancy together with pre-validated measurement items that improve future studies. In addition, we reason that vaccine hesitancy, while being an outcome of complex socio-political factors, is in itself an indicator for societal cohesion and anomie, the degree of which is associated with trust in (health) policy makers, (public) health authorities, health service providers, etc. Therefore, we further recommend that vaccine hesitancy questions should be integrated in pertinent national surveys.

Trusted information sources in the early months of the COVID-19 pandemic predict vaccination uptake over one year later

INTRODUCTION

COVID-19 vaccine uptake has been a major barrier to stopping the pandemic in many countries with vaccine access. This longitudinal study examined the capability to predict vaccine uptake from data collected early in the pandemic before vaccines were available.

METHODS

493 US respondents completed online surveys both at baseline (March 2020) and wave 6 (June 2021), while 390 respondents completed baseline and wave 7 (November 2021) surveys. The baseline survey assessed trust in sources of COVID-19 information, social norms, perceived risk of COVID-19, skepticism about the pandemic, prevention behaviors, and conspiracy beliefs. Multivariable logistic models examined factors associated with the receipt of at least one COVID-19 vaccine dose at the two follow-ups.

RESULTS

In the adjusted model of vaccination uptake at wave 6, older age (aOR = 1.02, 95 %CI = 1.00-1.04) and greater income (aOR = 1.69, 95 %CI = 1.04-2.73) was associated with positive vaccination status. High trust in state health departments and mainstream news outlets at baseline were positively associated with vaccination at wave 6, while high trust in the Whitehouse (aOR = 0.42, 95 %CI = 0.24-0.74) and belief that China purposely spread the virus (aOR = 0.66, 95 %CI = 0.46-0.96) at baseline reduced the odds of vaccination. In the adjusted model of vaccination uptake at wave 7, increased age was associated with positive vaccination status, and Black race (compared to white) was associated with negative vaccination status. High trust in the CDC and mainstream news outlets at baseline were both associated with being vaccinated at wave 7, while high trust in the Whitehouse (aOR = 0.24, 95 %CI = 0.11-0.51) and belief that the virus was spread purposefully by China (aOR = 0.60, 95 %CI = 0.39-0.93) were negatively associated with vaccination.

CONCLUSIONS

These findings indicated that vaccine uptake could be predicted over a year earlier. Trust in specific sources of COVID-19 information were strong predictors, suggesting that future pandemic preparedness plans should include forums for news media, public health officials, and diverse political leaders to meet and develop coherent plans to communicate to the public early in a pandemic so that antivaccine attitudes do not flourish and become reinforced.

Impact of a physician recommendation on COVID-19 vaccination intent among vaccine hesitant individuals

OBJECTIVE

To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy.

METHODS

We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, "Would you get vaccinated at this visit?".

RESULTS

Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially "not sure" and 13.1% of the initially "no" participants became less hesitant following any recommendation. Among the "not sure" participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%- 39.5% for the explicit recommendations. The "protect others" message was most effective among initially "no" participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation.

CONCLUSION

A physician recommendation may reduce COVID-19 vaccine hesitancy.

PRACTICE IMPLICATIONS

An explicit recommendation and "protect others" message appear to be important elements of a physician recommendation for COVID-19 vaccination.

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

STUDY GOAL

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

METHODS

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

RESULTS AND CONCLUSION

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

Information systems for vaccine safety surveillance

Immunization implementation in the community relies upon post-licensure vaccine safety surveillance to maintain safe vaccination programs and to detect rare AEFI not observed in clinical trials. The increasing availability of electronic health-care related data and correspondence from both health-related providers and internet-based media has revolutionized health-care information. Many and varied forms of health information related to adverse event following immunization (AEFI) are potentially suitable for vaccine safety surveillance. The utilization of these media ranges from more efficient use of electronic spontaneous reporting, automated solicited surveillance methods, screening various electronic health record types, and the utilization of natural language processing techniques to scan enormous amounts of internet-based data for AEFI mentions. Each of these surveillance types have advantages and disadvantages and are often complementary to each other. Most are "hypothesis generating," detecting potential safety signals, where some, such as vaccine safety datalinking, may also serve as "hypothesis testing" to help verify and investigate those potential signals.

Drivers of COVID-19 booster uptake among nurses

BACKGROUND

Nurses are at the forefront of efforts to contain COVID-19 and are thus at greater risk of infection from the virus than the general population. Unlike the initial vaccination, booster vaccinations are not always required, and some nurses have not received a booster shot. We investigate the predictors of booster uptake among nurses.

METHODS

We developed an original survey to study booster uptake among nurses. Using contact information from the South Dakota Board of Nursing, we contacted nurses in South Dakota in June and July of 2022. We conducted a multivariate logistic regression to analyze the data.

RESULTS

One thousand eighty-four nurses participated in our study. We found booster uptake among nurses was associated with their partisan self-identification (OR 0.40, 95% CI 0.31-0.52), age (OR 1.04, 95% CI 1.02-1.05), flu vaccination last season (OR 5.61, 95% CI 2.6-12.1), and positive COVID-19 test in last 12 months (OR 0.51, 95% CI 0.35-0.74).

DISCUSSION/CONCLUSIONS

Our results show that COVID-19 booster uptake has been politicized even among nurses. As public health officials continue devising interventions to increase booster uptake among healthcare workers, they should be mindful that they would be viewed through the partisan lens.

Partisanship and Covid-19 vaccination in the UK

This article examines the association between partisanship and vaccination in the UK. The lower vaccination rates among Republicans in the US have been linked to ideology and President Trump's anti-vaccination rhetoric. By contrast, both ruling and opposition parties in the UK promoted the national vaccination program. Using two datasets at constituency and individual levels, we analyse whether there are partisan differences in uptake when vaccination garners cross-party support. Our findings contrast in important ways from the US case. First, the correlation between partisanship and vaccination is the opposite to that of the US: both Conservative constituencies and individuals are associated with higher vaccination rates than Labour across almost all age groups. Thus, right-leaning individuals do not necessarily vaccinate less, at least when their political party is in power and supportive of vaccination. Second, partisanship alone accounts for a large share of variation in vaccination rates, but this association appears largely driven by socio-economic and demographic differences: older and economically better off individuals and constituencies tend to be more vaccinated. Once these controls are included, the correlation between Conservative partisanship and vaccination shrinks substantially. Hence, the ideological source of the partisan gap in vaccination rates appears smaller than in the US.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses

PURPOSE

The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected.

METHODS

This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them.

RESULTS

Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ 2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others.

CONCLUSION

The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.

The adoption of the HPV vaccine school-entry requirement in Puerto Rico: How practical lessons can inform future vaccine policies

Vaccine requirements are policy-level strategies used to improve population health outcomes; however, discourse politicization of vaccines may hinder adoption and implementation. An example of the complexities related to adoption of vaccine policies in the United States (US) is the human papillomavirus (HPV) vaccine school-entry requirement. In 2018, Puerto Rico's (PR) Department of Health adopted this policy. This study assessed stakeholders' recommendations for adoption of the HPV vaccine school-entry requirement that could inform future vaccine policies. Stakeholders (e.g., researchers, members of medical and non-profit organizations) were interviewed from May to August 2018. Participants (n = 20) discussed recommendations for public health professionals interested in adopting such policy. Data were analyzed using applied thematic techniques. Participants emphasized the importance of raising HPV vaccine awareness and providing education prior to the requirement. They recommended using real stories and making the problem relevant by using local data. Participants recommended considering the local culture and government bureaucracies, and promoting multisectoral collaborations to combine limited resources. The combination of education efforts, local data, and multisectoral collaborations facilitated the adoption of the HPV vaccine school-entry requirement in PR. Findings highlight the need to understand the contextual distinctions of the communities where vaccination requirements may be adopted and implemented to anticipate barriers and leverage existing resources. Consideration of the politico-cultural context may be important as political beliefs have become entrenched with vaccine policy. These practical lessons can inform public health professionals and policymakers who are seeking to adopt and implement vaccine policies in other settings to ensure equitable vaccine access.

HPV and COVID-19 vaccines: Social media use, confidence, and intentions among parents living in different community types in the United States

Our study measured parental confidence and intention/uptake of two adolescent vaccines (HPV and COVID-19), focusing on differences among community types including urban, suburban, and rural. Although social media provides a way for misinformation to spread, it remains a viable forum for countering misinformation and engaging parents with positive vaccine information across community types. Yet, little is understood about differences in social media use and vaccine attitudes and behaviors for parents living in rural, suburban and urban areas. We sought to determine how to better reach parents living in different community types with targeted social media channels and messaging. In August 2021, we used a cross-sectional survey programmed in Qualtrics to collect data from 452 parents of children ages 9 to 14 living in different community types across the United States. Participants came from a survey panel maintained by CloudResearch. Survey questions asked about demographics, political affiliation, community type, social media use, health and vaccine information sources, and attitudes and behaviors regarding the HPV and COVID-19 vaccines. Our sample of parents (n = 452) most frequently used Facebook (76%), followed by YouTube (55%), and Instagram (43%). When comparing social media use by community type, parents used the top platforms at similar rates. Social media use was associated with vaccine confidence and intention/uptake in unadjusted models but not in adjusted models. Further, there were no significant differences in HPV vaccine confidence or intention/uptake by community type (i.e., rural, suburban, urban). For the COVID-19 vaccine, parents in rural communities were less likely to have vaccine confidence and intention/uptake in the unadjusted model. For both HPV and COVID-19 vaccines, political affiliation was the only common factor associated with both vaccine confidence and intention/uptake. Parents who identified as Democrat compared to Republican had greater confidence in the vaccines and had higher odds of vaccine intention/uptake for their children. Although rurality has been associated with vaccine confidence in the past we did not find that in our study. Instead, political affiliation appeared to explain most of the variation in vaccine confidence and intention/uptake, suggesting that more research is needed to identify best practices for using social media to reach parents with different political beliefs.

Vaccinating across the aisle: using co-partisan source cues to encourage COVID-19 vaccine uptake in the ideological right

Overcoming the COVID-19 pandemic in the United States will require most Americans to vaccinate against the disease. However, considerable research suggests that a significant proportion of Americans intend to forego vaccination, putting pandemic recovery at risk. Republicans are one of the largest groups of COVID-19 vaccine hesitant individuals. Therefore, identifying strategies to reduce vaccine hesitancy within this group is vital to ending the pandemic. In this study, we investigate the effectiveness of messages from co-partisan sources in reducing vaccine hesitancy. In a large (N = 3000) and demographically representative survey, we find that exposing “Middle-of-the-Road” partisans to pro-vaccine messages from co-partisan source cues reduces vaccine hesitancy. However, for those who identify as “Strong” or “Weak” partisans, we find no statistically significant differences in vaccination intentions when exposed to pro-vaccine messages from co-partisan sources. We conclude by discussing how our findings are helpful for vaccine communication efforts.

The politics of vaccine hesitancy in Europe

BACKGROUND

Vaccine hesitancy threatens public health. Some evidence suggests that vaccine hesitancy in Europe may be linked with the success of populist parties, but more systematic analysis is needed.

METHODS

We examine the prevalence of individual-level vaccine hesitancy across the European Union (EU) and its association with political orientations. We also analyze whether success of populist parties is linked with vaccine hesitancy and uptake. We draw on individual-level Eurobarometer data from 2019, with a total of 27 524 respondents across the EU. We also rely on national and regional-level populist party vote shares. Finally, for a time-series analysis, we rely on aggregated populist party support as measured in the European Social Survey waves 1-9 (2002-18), and national immunization coverage rates from the WHO from 2002 to 2018.

RESULTS

While vaccine hesitancy is confined to a minority of the population, this group is large enough to risk herd immunity. Political orientations on a left-right dimension are not strongly linked to vaccine hesitancy. Instead, vaccine hesitancy is associated with anti-elite world views and culturally closed rather than cosmopolitan positions.

CONCLUSIONS

Vaccine hesitancy is not only present in all EU member states but also maps on broader dimensions of cultural conflict. Hesitancy is rooted in a broader worldview, rather than misperceptions about health risks. Pro-vaccine interventions need to consider the underlying worldview, rather than simply targeting misperceptions.

Improving vaccination intent among skeptics through confidence in governments' handling of the COVID-19 pandemic

Scientific evidence suggests that individuals vaccinated with COVID-19 vaccines are less likely to require hospitalization, possibly lowering the burden on the healthcare system. Despite such benefits, substantial segments of the world's population remain skeptical of COVID-19 vaccines and are hesitant to take them. Even if such individuals have been inoculated with COVID-19 vaccines out of economic, social, or legal necessity, they may be less inclined to receive booster shots or vaccinate their offspring when such options become available. What might help reduce this hesitancy? We examined this question using nationally representative survey data across 15 developed countries (max N = 122,516). Our findings suggest that inspiring confidence in the government's handling of the pandemic is pivotal in enhancing vaccination intent among vaccine skeptics. Specifically, results from a hierarchical linear analysis showed that among vaccine skeptics, confidence in the government's management of the pandemic was associated with greater intent to (a) take COVID-19 vaccines (b) take booster shots and (c) vaccinate one's children.

Video-based messages to reduce COVID-19 vaccine hesitancy and nudge vaccination intentions

Vaccines are highly effective for curbing the spread of SARS-CoV-2 (COVID-19). Yet, millions of Americans remain hesitant about getting vaccinated, jeopardizing our ability to end the COVID-19 pandemic by fueling the spread and development of new variants. We show that brief video-based messages of encouragement addressing specific COVID-19 vaccine concerns increase vaccination intentions, and that vaccination intentions, in turn, are predictive of future vaccine uptake. Results from our online experiment reveal that willingness to get vaccinated is driven by messages that increase confidence in COVID-19 vaccines and perceived behavioral control to get vaccinated. Importantly, messages were particularly effective among more skeptical populations including people who identify as politically conservative or moderate and those who express low trust in government institutions. Our findings corroborate the real-world behavioral significance of vaccination intentions, and devise how even short, scalable online messages can provide governments and health authorities an inexpensive, yet effective tool for increasing intentions to vaccinate against COVID-19 among populations most reluctant to get them.

Communicating science and protecting scientists in a time of political instability

The coronavirus disease 2019 (COVID-19) pandemic will change how we communicate biomedical science to reflect the new realities of increasing politicization of vaccines or therapeutics, as well as targeted attacks against prominent US scientists. The stakes are high, given how thousands of Americans are losing their lives by refusing vaccinations or demanding unproven treatments.

Crisis of confidence in vaccination and the role of social media

INTRODUCTION

The aim of this paper is to review the current situation of vaccine hesitancy, with emphasis on children with neurological disorders, and to present the role social media plays in this situation.

METHODS

A literature review using the following search words was performed: vaccine∗ OR immune∗ AND hesitancy OR confidence AND social media.

RESULTS

The search retrieved 277 results; 17 duplicates and 234 irrelevant articles were excluded. 43 articles were fully analyzed.

CONCLUSIONS

An increasing number of parents are becoming vaccine hesitant. Their motives are complex and nuanced and involve factors related to vaccine safety and efficiency, perceived personal risks and benefits, socio-demographic and psychological characteristics. Attitudes toward vaccination differ in adolescents from their parents. In children with neurological disorders, factors involved in vaccination decision included physicians' knowledge of neurological diseases and parents' concerns that vaccination would exacerbate the chronic disorder. Unfortunately, the current pandemic is associated with an increase in vaccine hesitancy and brought forward unique determinants. The social media platforms can be a tool for the anti-vaccine movement to spread misinformation, but it can also be valued as a way for promoting health and pro-vaccine information.