Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic

The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

The impact of risk perception and institutional trust on COVID-19 vaccine hesitancy in China

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

The Roles of Social Media Use and Medical Mistrust in Black Americans' COVID-19 Vaccine Hesitancy: The RISP Model Perspective

The COVID-19 pandemic has brought unprecedented challenges to healthcare and public health messaging in the United States. One area of focus has been vaccination uptake among Black Americans, who have experienced COVID-19 deaths disproportionate to their share of the United States population, raising questions about the processes involved in vaccination perceptions and behaviors. Guided by the Risk Information Seeking and Processing model, this study explored the roles of medical mistrust and social media as a source of risk information in Black Americans' vaccine hesitancy. Survey results from a YouGov panel sample of Black Americans (n = 1,136; 53.5% female) showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine, which, in turn, was positively related to vaccine hesitancy through perceived information insufficiency and information seeking intentions. Furthermore, we found that belief in misinformation and subjective norms toward anti-vaccination also serially mediated the association between social media use and medical mistrust with vaccine hesitancy. Theoretical and practical implications are discussed.

Advancing Vaccine Uptake in People With HIV: A Call for Research on Trust and Intellectual Humility in Health Care

ABSTRACT

This article addresses the challenge of vaccine hesitancy among people with HIV (PWH), emphasizing the need for research on the potential impact of trust and intellectual humility in health care. It underscores the complexity of vaccine acceptance in PWH and the urgency of addressing hesitancy in PWH ahead of a future HIV vaccine. The article identifies trust in health care providers as a critical factor influencing vaccine uptake and proposes that providers who demonstrate intellectual humility-openly recognizing the limits of their knowledge-might enhance patient trust. The role of nurses is spotlighted because of their social positioning in the patient experience. The article advocates for interventions tailored to PWH's unique experiences and attitudes. Such strategies are essential for improving vaccine uptake and, consequently, public health outcomes.

Understanding the impact of the COVID-19 pandemic and its control measures on women and children: A Zimbabwe case study

COVID-19 presented countries with unprecedented health policy challenges. For low-income countries in particular, policymakers had to contend with both the direct threats posed by COVID-19 as well as the social, educational, and economic harms associated with lockdown and other infection prevention and control measures. We present a holistic and contextualised case study of the direct and indirect impacts of COVID-19 on women and children, with some assessment of their uneven distribution across socio-economic, age and gender groups. We used different types of primary and secondary data from multiple sources to produce a holistic descriptive analysis. Primary data included: qualitative data obtained from 28 in-depth interviews of key informants, six focus group discussions; and 40 household interviews. We also extracted data from government reports and announcements, the District Health Information Software version 2 (DHIS2), newspaper articles and social media, as well as from published research articles. Our findings show that the direct and indirect adverse impacts of COVID-19 were compounded by many years of severe political economic challenges, and consequent deterioration of the healthcare system. The indirect effects of the pandemic had the most severe impacts on the poorest segment of society and widened age and gender inequalities. The pandemic and its accompanying infection prevention and control measures negatively affected health service delivery and uptake. The management of COVID-19 presented enormous challenges to policymakers and public health specialists. These included managing the greatest tension between direct and indirect harms; short-term and long-term effects; and the unequal distribution of harms across different segments of society.

Predicting vaccination hesitancy: The role of basic needs satisfaction and institutional trust

Autonomous motivation is considered a powerful driver of health behaviour, but less is known about the specific roles played by basic needs. Drawing on the context of the COVID-19 pandemic, this research examined basic needs as a motivational determinant of vaccination. We hypothesized that satisfaction of basic needs (autonomy, competence, relatedness) has both a direct and an indirect effect (through trust in science and government) on vaccine hesitancy. Two studies (Study 1: N = 968 French and British; Study 2, pre-registered: N = 716 Americans) tested our hypotheses and compared vaccinated and non-vaccinated individuals using multigroup structural equation models. We found positive direct (in both studies) and indirect (in Study 1) effects of autonomy satisfaction on vaccine acceptance. In contrast, competence satisfaction was directly and indirectly, via science mistrust, related to vaccine hesitancy, particularly among non-vaccinated people. Competence satisfaction also indirectly reduced the intention to vaccinate in both studies. We found no impact of relatedness. Complementing previous work on self-determination theory, our research demonstrates the importance of considering the distinct roles of basic needs. Moreover, we highlight that increasing autonomy and science trust may be an efficient strategy to improve vaccine acceptance and vaccination, even among reluctant individuals.

Immunization against Medically Important Human Coronaviruses of Public Health Concern

SARS-CoV-2 is a virus that affects the human immune system. It was observed to be on the rise since the beginning of 2020 and turned into a life-threatening pandemic. Scientists have tried to develop a possible preventive and therapeutic drug against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other related coronaviruses by assessing COVID-19-recovered persons' immunity. This study aims to review immunization against SARS-CoV-2, along with exploring the interventions that have been developed for the prevention of SARS-CoV-2. This study also highlighted the role of phototherapy in treating SARS-CoV infection. The study adopted a review approach to gathering the information available and the progress that has been made in the treatment and prevention of COVID-19. Various vaccinations, including nucleotide, subunit, and vector-based vaccines, as well as attenuated and inactivated forms that have already been shown to have prophylactic efficacy against the Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV, have been summarized. Neutralizing and non-neutralizing antibodies are all associated with viral infections. Because there is no specific antiviral vaccine or therapies for coronaviruses, the main treatment strategy is supportive care, which is reinforced by combining broad-spectrum antivirals, convalescent plasma, and corticosteroids. COVID-19 has been a challenge to keep reconsidering the usual approaches to regulatory evaluation as a result of getting mixed and complicated findings on the vaccines, as well as licensing procedures. However, it is observed that medicinal herbs also play an important role in treating infection of the upper respiratory tract, the principal symptom of SARS-CoV due to their natural bioactive composite. However, some Traditional Chinese Medicines contain mutagens and nephrotoxins and the toxicological properties of the majority of Chinese herbal remedies are unknown. Therefore, to treat the COVID-19 infection along with conventional treatment, it is recommended that herb-drug interaction be examined thoroughly.

Ethico-racial positioning in campaigns for COVID-19 research and vaccination featuring public figures

This article analyses a set of videos which featured public figures encouraging racially minoritised people in the UK to take the COVID-19 vaccine or get involved in related research. As racially targeted health communication has both potentially beneficial and problematic consequences, it is important to examine this uniquely high-profile case. Using a purposive sample of 10 videos, our thematic content analysis aimed to reveal how racially minoritised people were represented and the types of concerns about the vaccine that were expressed. We found representations of racialised difference that centred on 'community' and invoked shared social experiences. The expressed concerns centred on whether ethnic difference was accounted for in the vaccine's design and development, plus the overarching issue of trust. Our analysis adopts and develops the concept of 'racialisation'; we explore how 'mutuality' underpinned normative calls to action ('ethico-racial imperatives') and how the videos 'responsibilised' racially minoritised people. We discuss two points of tension in this case: the limitations for addressing the causes of mistrust and the risks of reductivism that accompanied the ambiguous notion of community. Our analysis develops scholarship on racialisation in health contexts and provides public health practitioners with insights into the socio-political considerations of racially targeted communications.

How to increase acceptance of the COVID-19 vaccine among poor people in Africa?

This study aims to analyze whether good government management of the COVID-19 pandemic can increase the likelihood of vaccine uptake among poor people in Africa. The analysis is based on a sample of 18,010 people living in 34 African countries, drawn from data collected by Afrobarometer (Merged Round 8 data (34 countries), database, 2022). The econometric results, obtained using a bivariate probit regression, show that poverty significantly reduces the odds of accepting the said COVID-19 vaccine. However, acceptance of the vaccine increases among poor individuals when there is (i) trust in the government's published statistics on COVID-19, (ii) control of corruption by the government in managing the pandemic, (iii) individual confidence in the government's ability to ensure the safety of the COVID-19 vaccine, and (iv) belief that the Covid 19 vaccine will be more effective than religious prayer in the fight against this pandemic.

Gender and vaccination: understanding the multifaceted role of a multidimensional conceptualization of vaccine hesitancy

Popular press and academic articles alike speculate that gender influences vaccine receipt, but they often disagree whether men or women are less likely to become vaccinated. In the current article, we further test the relation of gender and vaccination in four datasets, and we assess the mediating role of vaccine hesitancy dimensions. Our results demonstrate that: (1) gender has significant relations with several vaccine hesitancy dimensions, which are mixed between both women and men having negative perceptions regarding vaccination; (2) gender does not significantly relate to flu and COVID-19 vaccination willingness or receipt, but women were more likely to receive other vaccines; and (3) a significant indirect effect did emerge in the two datasets collected after widespread access to the COVID-19 vaccine, such that the perception that vaccines cause health risks mediates the relation of gender with flu vaccination willingness as well as COVID-19 vaccination willingness and receipt. Our discussion integrates these findings with models of preventative behaviors and identifies directions for future research.

Reliance on sources of immunization information and vaccine uptake among older adults in a rural state: The mediating role of trust

Older adults are more vulnerable to the negative impacts of infectious diseases than younger individuals. However, regardless of the importance and effectiveness of vaccines to reduce morbidity and mortality, issues remain with vaccine hesitancy among this population. Older adults' sources of immunization information and their level of trust in those sources may play a role in their vaccination behaviors. This research aimed to better understand the role of information sources and related issues of trust as related to vaccine uptake among older adults. A community-based, cross-sectional survey was conducted with 901 older adults in North Dakota in May-July 2022. Measures included extent of reliance on specific sources of immunization information, levels of trust, and uptake for influenza, pneumonia, shingles, and COVID-19 vaccinations. Immunization information sources were grouped into medical experts, informal, and public outlets. Results indicated older adults were more likely to rely on medical experts than informal sources or public outlets for immunization information. Greater reliance on medical experts was associated with a greater likelihood of vaccine uptake for all vaccines, while reliance on public outlets was associated with a greater likelihood of vaccine uptake only for COVID primary series and boosters. Reliance on informal sources for immunization information was associated with a reduced likelihood of vaccine uptake for all vaccines except shingles. Nearly half of respondents were uncertain who to trust for vaccine information. Uncertainty who to trust for immunization information significantly mediated the associations between reliance on medical experts and uptake for most vaccines indicating that trust in medical experts fosters vaccine uptake. Increasing reliance on medical experts as sources of immunization information is vital to increasing vaccine uptake among older adults. Additionally, this population must be assisted in increasing their ability to successfully assess the trustworthiness of immunization information sources.

[Asymmetries between national articulation and the autonomy of state governments in implementing health technologies to fight COVID-19 in Argentina]

Argentina, as other countries, showed several public policies related to the health technologies implemented to fight and treat the COVID-19 pandemic. This study sought to analyze how articulation vs. cooperation and autonomy vs. division of powers between entities occurred in Argentina, exploring asymmetries between several entities in implementing public policies related to health technologies during the pandemic and the influences of other actors. For this, a documentary research was carried out related to 2020-2021 (technical reports published by the World Health Organization, national agencies and scientific societies, laws, court decisions, press, and research and in-depth interviews with members of the Argentine Ministries of Health). The processes and results of decision-making in the Ministries of Health were analyzed, outlining the coverage and orientations of each technology and the political party in power in the province. This study found heterogeneous results and processes between Ministries and disputes within them. It also observed the poor adherence to official guidelines due to technical-political criteria (power relations, social, media, academic, judiciary, and legislative pressure). Some cases showed a strong tension between the government and its opposition over the discussion of technologies. Each province in Argentina has autonomously defined its policies on health technologies for COVID-19, and decision-making in public administration was disorderly, complex, and non-linear during the pandemic.

Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region

BACKGROUND

There are clear inequalities in COVID - 19 vaccination rates amongst marginalised groups, with lower rates for some minoritised ethnic and religious groups, younger people, those living in more deprived areas, and with lower socio-economic status. Existing research focuses on psychological and socio-economic factors that influence vaccine uptake and does not explore broader social and historical contexts. Understanding inequalities in COVID-19 vaccine uptake requires a critical examination of the drivers of, and barriers to, vaccination.

METHODS

We present findings from a co-designed qualitative research study undertaken during the COVID-19 pandemic. Focus groups and interviews were used to examine the context underpinning responses to the COVID-19 vaccination in Greater Manchester, particularly focussing on experiences of marginalisation. Thematic framework analysis was used to analyse the data.

RESULTS

We found that the public's responses to the COVID-19 vaccination programme are intertwined with a longstanding history of institutional distrust and disenfranchisement, resulting from experiences of marginalisation and social inequalities. This was exacerbated further by the disproportionate impacts of the COVID-19 pandemic on minoritised ethnic groups, younger people, and those with existing health conditions.

CONCLUSIONS

Histories of structural inequalities experienced by minoritised groups invoked feelings of suspicion and scepticism at the motivations of the agencies behind the vaccination rollout. This highlights the need for a contextualised analysis of attitudes to vaccines, considering pre-existing inequalities, which may be especially relevant for conceptualising public responses to the vaccination programme. Finally, our study shows the important ways in which public (dis)trust can impact public health policies. We recommend this should be incorporated into responses to future public health crises.

The impact of health beliefs and trust in health information sources on SARS-CoV-2 vaccine uptake

Background

Health beliefs may mediate the relationship between trust and vaccination decisions, as confidence in online health information has expanded quickly. However, little is known about how health attitudes and trust in health information affect COVID-19 vaccine intention. This study aimed to assess the effect of health beliefs and trust in information sources on the willingness to receive a COVID-19 vaccine among the general public in Saudi Arabia.

Methods

This study was designed and carried out at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Selected items were extracted from the Saudi Residents' Intention to Get Vaccinated Against COVID-19 (SRIGVAC) survey. They were categorized and validated into constructs of a health belief model (the perceived threat of COVID-19, vaccine-related benefits, barriers, and safety concerns) and trust in health information (from online platforms and health authorities/providers). Regression analysis and parallel mediation were used to assess the predictors of vaccination intentions.

Results

Based on the responses of 3,091 participants, vaccine-related barriers and safety concerns negatively influenced vaccination intention, whereas vaccine benefits and the perceived threat of COVID-19 were positively correlated with vaccination intention. Trust in online health information had a direct relationship with intentions (β = 0.09, p < 0.0001) as well as indirect relationships through the perceived benefits (β = 0.095), the perceived barriers (β = -0.029), and the perceived safety concerns toward the vaccine (β = -0.010). The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs, with indirect coefficients of 0.004, 0.310, -0.134, and -0.031 for the perceived threat, vaccine benefits, barriers, and safety concerns, respectively.

Conclusion

The relationship between the willingness to vaccinate and trust in authentic information was fully mediated by all domains of health beliefs. Vaccine coverage in Saudi Arabia can be optimized by targeting the health beliefs of the general public.

Trends in U.S. public confidence in science and opportunities for progress

In recent years, many questions have been raised about whether public confidence in science is changing. To clarify recent trends in the public's confidence and factors that are associated with these feelings, an effort initiated by the National Academies' Strategic Council for Research Excellence, Integrity, and Trust (the Strategic Council) analyzed findings from multiple survey research organizations. The Strategic Council's effort, which began in 2022, found that U.S. public confidence in science, the scientific community, and leaders of scientific communities is high relative to other civic, cultural, and governmental institutions for which researchers regularly collect such data. However, confidence in these institutions has fallen during the previous 5 years. Science's decline, while real, is similar to or less than that in the other groups. A recent study goes into greater detail by exploring public views of science. From these data, we observe that many of the surveyed U.S. public question the extent to which scientists share their values or overcome personal biases when presenting conclusions. At the same time, large majorities agree on certain types of actions that they want scientists to take. For example, 84% respond that it is "somewhat important" or "very important" for scientists to disclose their funders. Ninety-two percent (92%) offer the same responses to scientists "being open to changing their minds based on new evidence." Collectively, these data clarify how the U.S. public views science and scientists. They also suggest actions that can affect public confidence in science and scientists in the years to come.

COVID-19 vaccine hesitancy and influencing factors among Chinese hospital staff: a cross-sectional study

We aimed to investigate the willingness of hospital staff to receive the COVID-19 vaccine and explore the associated factors and reasons of vaccine hesitancy among Chinese hospital staff, which were not yet known. A cross-sectional questionnaire survey was conducted online on the vaccine hesitancy of staff in a grade A tertiary general hospital in Beijing from February 22 to 23, 2023. Univariate and multivariate logistic regression were used to assess associations between potential influencing factors and vaccine hesitancy. A total of 3269 valid respondents were included, and the rate of COVID-19 vaccine hesitancy was 32.67%. Multivariate logistic regression showed that women [1.50 (1.22-1.83)], having high-school education level [1.69 (1.04-2.76)], college degree [2.24 (1.35-3.72)] or graduate degree [2.31 (1.33-4.03)], and having underlying disease [1.41 (1.12-1.77)] were associated with a higher rate of COVID-19 vaccine hesitancy. The main reasons for vaccine hesitancy included doubts for the safety and effectiveness of COVID-19 vaccine and worries in adverse reactions. Hospital staff's willingness to vaccinate COVID-19 vaccine is generally high in the study. Hospitals should spread the knowledge of COVID-19 vaccine through multiple channels to improve the cognition of hospital staff and encourage vaccination based on associated factors.

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.

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

Why did Brazil fail to vaccinate children against COVID-19 during the pandemic? An assessment of attitudinal and behavioral determinants

The objective of this study is to identify the determining attitudinal, behavioral, and sociodemographic factors behind the vaccination decision of parents and guardians in Brazil regarding immunization of children against COVID-19. Our data is obtained from a national online survey of 1,872 parents or guardians of children between 5 and 11 years of age, conducted from May 16 to 25, 2022. Our results show that, in Brazil, the decision to vaccinate children against COVID-19 is better explained by attitudinal and behavioral factors than sociodemographic ones. More precisely, the choice to immunize children against COVID-19 is strongly associated with the parents or guardians' own COVID-19 vaccination status, their ambivalence regarding this decision, their political preferences, and media use. In particular, parents and guardians who did not vaccinate against SARSCov2 and who supported former president Jair Bolsonaro (the main anti-vaccine political leader in the country during the COVID-19 pandemic) were substantially less likely to vaccinate their children. Parents and guardians with greater exposure to the country's major TV news program (Jornal Nacional/TV Globo), however, were more likely to do so. Other findings show that evangelicals - whose religious leaders strongly supported the former president -, young parents and guardians, and those from lower economic status were also less likely to vaccinate their children.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study

Introduction

The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic.

Materials and methods

This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios.

Results

Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders.

Discussion

The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations

RATIONALE

Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes.

OBJECTIVE

The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations.

METHOD

We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles.

RESULTS

The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions.

CONCLUSIONS

While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.

Does COVID-19 vaccination affect post-traumatic stress symptoms via risk perception? A large cross-sectional study among the Chinese population

OBJECTIVES

Although infection rates may increase after relaxation of the zero COVID strategy, the extensive vaccination campaign in China could potentially curb the spread of COVID-19, which may be associated with a low level of risk perception and post-traumatic stress symptoms (PTSS). However, the relationship between vaccination, risk perception and PTSS has not been studied extensively. This study aims to examine the associations between the number of COVID-19 vaccine doses, consistency in the type of each dose and time since vaccination with PTSS, and the mediating role of risk perception on such relationships in China.

STUDY DESIGN

Cross-sectional sampling with a self-report questionnaire was used to measure vaccination, PTSS and risk perception.

METHODS

The survey was conducted in Beijing, China, from 13 January to 9 February 2023. Linear regression analyses were conducted to test the relationship between vaccination, risk perception and PTSS.

RESULTS

The analysis included 55,803 individuals. In total, 72.86 % of participants received two doses of the COVID-19 vaccine. Regression results indicated that people with two doses of the COVID-19 vaccine had a lower level of PTSS (β = -1.232, 95 % confidence interval [CI]: -1.930, -0.534) than those who had not received any doses of the COVID-19 vaccine. Only the negative relationship between two-dose vaccination and PTSS was mediated by risk perception, while the negative relationship between the time since vaccination and PTSS was suppressed by risk perception.

CONCLUSIONS

This study showed that receiving the COVID-19 vaccine reduced PTSS by decreasing perceived risk. Vaccination time was negatively associated with PTSS, but this relationship was suppressed by risk perception.

Modeling the potential public health and economic impact of different COVID-19 booster dose vaccination strategies with an adapted vaccine in the United Kingdom

BACKGROUND

Updating vaccines is essential for combatting emerging coronavirus disease 2019 (COVID-19) variants. This study assessed the public health and economic impact of a booster dose of an adapted vaccine in the United Kingdom (UK).

METHODS

A Markov-decision tree model estimated the outcomes of vaccination strategies targeting various age and risk groups in the UK. Age-specific data derived from published sources were used. The model estimated case numbers, deaths, hospitalizations, medical costs, and societal costs. Scenario analyses were conducted to explore uncertainty.

RESULTS

Vaccination targeting individuals aged ≥ 65 years and the high-risk population aged 12-64 years was estimated to avert 701,549 symptomatic cases, 5,599 deaths, 18,086 hospitalizations, 56,326 post-COVID condition cases, and 38,263 lost quality-adjusted life years (QALYs), translating into direct and societal cost savings of £112,174,054 and £542,758,682, respectively. The estimated economically justifiable price at willingness-to-pay thresholds of £20,000 and £30,000 per QALY was £43 and £61, respectively, from the payer perspective and £64 and £82, respectively, from the societal perspective. Expanding to additional age groups improved the public health impact.

CONCLUSIONS

Targeting individuals aged ≥ 65 years and those aged 12-64 years at high risk yields public health gains, but expansion to additional age groups provides additional gains.

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.

Impact of the COVID-19 Pandemic on Physical Activity among Mostly Older, Overweight Black Women Living in the Rural Alabama Black Belt

Despite well-documented global declines in physical activity (PA) during the COVID-19 pandemic, little is known regarding the specific impact among underserved, rural Alabama counties. This is concerning as this region was already disproportionately burdened by inactivity and related chronic diseases and was among the hardest hit by COVID-19. Thus, the current study examined the effect of COVID-19 on PA in four rural Alabama counties. An ancillary survey was administered between March 2020 and August 2021 to the first cohort (N = 171) of participants enrolled in a larger PA trial. Main outcomes of this survey included the perceived impact of COVID-19 on PA, leisure-time PA, and social cognitive theory (SCT) constructs at 3 months. Almost half of the participants reported being less active during the pandemic (49.7%) and endorsed that COVID-19 made PA more difficult (47.4%), citing concerns such as getting sick from exercising outside of the home (70.4%) and discomfort wearing a face mask while exercising (58%). Perceived COVID-19 impact on PA was significantly associated with education, household dependents, and gender (p's < 0.05). More women, parents, and college graduates reported that the COVID-19 pandemic made PA more difficult. Overall, there were no significant associations between PA, SCT constructs, or perceived COVID-19 impact on PA scores at 3 months. While the pandemic made PA difficult for many participants, these barriers were not associated with leisure-time PA levels or related theoretical mechanisms of action, which bodes well for the success of our ongoing intervention efforts and the resiliency of these communities.

Correlation between coronavirus conspiracism and antisemitism: a cross-sectional study in the United Kingdom

This article presents the findings of a survey of UK-resident adults ([Formula: see text] = 1790) carried out in December 2021 and designed to test for a relationship between antisemitism and coronavirus conspiracism. Antisemitism was measured using the Generalised Antisemitism (GeAs) scale, and coronavirus conspiracism was measured using a version of the Flexible Inventory of Conspiracy Suspicions (FICS). Hypotheses and methodology were pre-registered, and all data and code are open. There was found to be a positive correlation between coronavirus conspiracy suspicions and Generalised Antisemitism, robust to demographic controls. This correlation appears to be entirely accounted for by older forms of antisemitism: antisemitism as expressed in relation to Israel and its supporters was found to be associated with coronavirus conspiracism only because both of these variables were associated with antisemitism as expressed in relation to Jews identified as Jews. Statistical analysis suggests that these findings may be generalised from the sample to the UK adult population with some confidence, although no data were collected in other national contexts, such that generalisation to other national contexts must remain speculative.

Contextual Pathways Linking Cumulative Experiences of Racial Discrimination to Black American Men's COVID Vaccine Hesitancy

The COVID-19 pandemic has revealed and widened racialized health disparities, underscoring the impact of structural inequities and racial discrimination on COVID-19 vaccination uptake. A sizable proportion of Black American men report that they either do not plan to or are unsure about becoming vaccinated against COVID-19. The present study investigated hypotheses regarding the mechanisms by which experiences of racial discrimination are associated with Black American men's COVID-19 vaccine hesitancy. Hypotheses were tested using structural equation modeling with 4 waves of data from 242 Black American men (aged ~ 27) living in resource-poor communities in the rural South. Study findings revealed that racial discrimination was indirectly associated with COVID-19 vaccine hesitancy via increased endorsement of COVID-19 conspiratorial beliefs. Findings also demonstrated that increased levels of ethnic identity strengthen the association between experiences of racial discrimination and COVID-19 conspiratorial beliefs. In contrast, increased levels of social support weakened the association between cumulative experiences of racial discrimination and COVID conspiratorial beliefs. Taken together, these results suggest that racial discrimination may promote conspiratorial beliefs which undermine Black American men's willingness to be vaccinated. Future interventions aimed towards promoting vaccine uptake among Black American men may benefit from the inclusion of targeted efforts to rebuild cultural trust and increase social support.

Online health information seeking and Covid-19 vaccine hesitancy: Evidence from 50+ Europeans

We use recently released data from the Survey of Health Ageing and Retirement in Europe (SHARE) to investigate the role of online health information seeking on Covid-19 vaccine hesitancy, which is defined as the reluctance or refusal to receive vaccinations despite the availability of vaccines. We adopt an instrumental variable strategy that exploits the computerization of workplaces occurred in the last century to deal with endogeneity. We find that searching for health information strongly reduces vaccine hesitancy. Results also show that individuals whose social networks suffered more during the outbreak, in terms of hospitalisations and deaths, are less likely to be hesitant. Improving individuals' technological skills might have positive spill-over effects for public health.

Unraveling the association between vaccine attitude, vaccine conspiracies and self-reported side effects following COVID-19 vaccination among nurses and physicians in Jordan

Background

The negative impact of vaccine conspiracies is linked with negative health behavior. The aim of the current study was to examine the association between attitudes toward booster COVID-19, influenza, and monkeypox (mpox) vaccinations with post-COVID-19 vaccine side effects, vaccine conspiracies, and attitude towards mandatory vaccination among nurses and physicians in Jordan.

Methods

A structured closed-ended questionnaire was used to collect data on demographics, COVID-19 history, COVID-19 vaccine type and doses received, self-reported side effects post-COVID-19 vaccination, acceptance of booster COVID-19, seasonal influenza, and mpox vaccinations, attitudes towards mandatory vaccination, and beliefs in vaccine conspiracies.

Results

The study sample comprised a total of 341 participants. Acceptance of yearly booster COVID-19 vaccination was expressed by 46.6% of the sample, while 73.3% accepted seasonal influenza vaccination, and only 37.0% accepted mpox vaccination. A higher frequency of self-reported side effects following the first COVID-19 vaccine dose was associated with embrace of vaccine conspiracies and vaccine type. For the second vaccine dose, a higher frequency of self-reported side effects was associated with the embrace of vaccine conspiracies, older age, and affiliation to private sector. In multinomial logistic regression analyses, the lower embrace of vaccine conspiracies was associated with lower odds of reporting side effects post-COVID-19 vaccination. The lower embrace of vaccine conspiracies and favorable attitude towards mandatory vaccination were associated with the willingness to get COVID-19, influenza, and mpox vaccinations.

Conclusion

The study findings highlighted the negative impact of embracing vaccine conspiracies on health-seeking behavior among nurses and physicians. The findings indicated that the willingness to get vaccinated was associated with lower endorsement of vaccine conspiracies. Additionally, the lower embrace of vaccine conspiracies was associated with a lower frequency of self-reported side effects following COVID-19 vaccination. These results emphasize the importance of addressing vaccine misinformation and promoting accurate information to ensure optimal vaccine uptake and public health outcomes.

Exploring COVID-19 conspiracy theories: education, religiosity, trust in scientists, and political orientation in 26 European countries

The COVID-19 virus disseminated globally at an accelerated pace, culminating in a worldwide pandemic; it engendered a proliferation of spurious information and a plethora of misinformation and conspiracy theories (CTs). While many factors contributing to the propensity for embracing conspiracy ideation have been delineated, the foremost determinant influencing individuals' proclivity towards CT endorsement appears to be their level of educational attainment. This research aimed to assess the moderating effect of religiosity, trust in scientists, and political orientation on the impact of education level on people's belief in COVID-19-related CTs in Europe by considering both individual-level and country-level contextual covariates of CT. We analysed data from the newest European Social Survey (ESS10) round conducted between September 2020 and September 2022 in 26 countries. We found religiosity weakens, and trust in scientists strengthens the effect of education, while the impact of political orientation is not straightforward. The result also demonstrates a significant negative correlation between the aggregate country-level data of the respondents supporting CTs and the level of vaccination and cumulative excess deaths in Europe. We concluded with a recommendation that planning effective public health strategies and campaigns are insufficient when based solely on people's education, as individuals' beliefs moderate the effect of education.

Development and validation of the Trust in Government measure (TGM)

BACKGROUND

Trust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations related to reliability and validity. To address the limitations of existing measures available to track public trust, the aim of the present work was to develop a new measure of trust in government.

METHODS

Fifty-six qualitative interviews (Aug-Oct 2021; oversampling for equity-deserving populations) were conducted to design a national survey, including factor analyses and validation testing (N = 878; June 1-14th 2022) in Canada.

RESULTS

The measure demonstrated strong internal consistency (α = 0.96) and test validity (CFI = 0.96, RMSEA = 0.09, SRMR = 0.03), suggesting that trust in government can be measured as a single underlying construct. It also demonstrated strong criterion validity, as measured by significant (p < 0.0001) associations of scores with vaccine hesitancy, vaccine conspiracy beliefs, COVID-19 conspiracy beliefs, trust in public health messaging about COVID-19, and trust in public health advice about COVID-19. We present the Trust in Government Measure (TGM); a 13-item unidimensional measure of trust in Federal government.

CONCLUSIONS

This measure can be used within high-income countries, particularly member countries within the OECD already in support of using tools to collect, publish and compare statistics. Our measure should be used by researchers and policy makers to measure trust in government as a key indicator of societal and public health.

"I am Young, Why Should I Vaccinate?" How empathetic and aggressive communication on social media impact young adults' attitudes toward COVID-19 vaccination

Introduction

To combat the current COVID-19 pandemic, high vaccination rates are of crucial value. However, young people in particular tend to be hesitant toward vaccination. On social media, young adults are often called to vaccinate in an aggressive tone, arguing that there is no choice than to vaccinate and that all else is wrong.

Methods

In an experimental study (N = 410), we investigated the effects of (a) empathetic vs. aggressive communication styles in social media postings and (b) the origin of the communicator on young adults' supportive attitudes toward COVID-19 vaccinations. We treated the gender of the communicator as a moderator, and expectancy violation, psychological distance as well as the perceived credibility of the communicator as mediators.

Results

Findings showed that an aggressive communication style generally had a negative impact on young adults' COVID-19 vaccination attitudes, fully mediated by expectancy violation and perceived credibility of the communicator. Gender and the origin of the communicator did not moderate this mediation processes.

Discussion

Further implications for online health communication strategies are discussed.

How Should Doctors Frame the Risk of a Vaccine's Adverse Side Effects? It Depends on How Trustworthy They Are

BACKGROUND

How health workers frame their communication about vaccines' probability of adverse side effects could play an important role in people's intentions to be vaccinated (e.g., positive frame: side effects are unlikely v. negative frame: there is a chance of side effects). Based on the pragmatic account of framing as implicit advice, we expected that participants would report greater vaccination intentions when a trustworthy physician framed the risks positively (v. negatively), but we expected this effect would be reduced or reversed when the physician was untrustworthy.

DESIGN

In 4 online experiments (n = 191, snowball sampling and n = 453, 451, and 464 UK residents via Prolific; Mage≈ 34 y, 70% women, 84% White British), we manipulated the trustworthiness of a physician and how they framed the risk of adverse side effects in a scenario (i.e., a chance v. unlikely adverse side effects). Participants reported their vaccination intention, their level of distrust in health care systems, and COVID-19 conspiracy beliefs.

RESULTS

Physicians who were trustworthy (v. untrustworthy) consistently led to an increase in vaccination intention, but the way they described adverse side effects mattered too. A positive framing of the risks given by a trustworthy physician consistently led to increased vaccination intention relative to a negative framing, but framing had no effect or the opposite effect when given by an untrustworthy physician. The exception to this trend occurred in unvaccinated individuals in experiment 3, following serious concerns about one of the COVID vaccines. In that study, unvaccinated participants responded more favorably to the negative framing of the trustworthy physician.

CONCLUSIONS

Trusted sources should use positive framing to foster vaccination acceptance. However, in a situation of heightened fears, a negative framing-attracting more attention to the risks-might be more effective.

HIGHLIGHTS

How health workers frame their communication about a vaccine's probability of adverse side effects plays an important role in people's intentions to be vaccinated.In 4 experiments, we manipulated the trustworthiness of a physician and how the physician framed the risk of adverse side effects of a COVID vaccine.Positive framing given by a trustworthy physician promoted vaccination intention but had null effect or did backfire when given by an untrustworthy physician.The effect occurred over and above participants' attitude toward the health care system, risk perceptions, and beliefs in COVID misinformation.

Comprehensive evaluation of the effect of inactivated SARS-CoV-2 vaccination on female fertility: A retrospective cohort study

Fear of possible negative effects of coronavirus disease 2019 (COVID-19) vaccine on fertility is the main reason for vaccine hesitancy among the public especially women of childbearing age. Despite the high coverage of COVID-19 vaccination in China, more scientific evidence is still needed to address their concerns and guide fertility counseling and management in the future. Herein, we performed a retrospective cohort study at a single large center for reproductive medicine in China between August 2020 and May 2023. Patients aged 20-42 years with no history of laboratory-confirmed COVID-19 were included and categorized into different groups according to their vaccination status. The serum sex hormone levels, anti-Müllerian hormone concentrations, embryo quality, and pregnancy outcomes were evaluated and compared among them. We found there were no significant differences in the concentrations of follicle-stimulating hormone, luteinizing hormone and progesterone between the unvaccinated, first-dose, second-dose, and booster vaccinated groups. However, the estradiol showed a highly significant increase in the one-dose vaccinated group compared with its levels in other groups. Among unvaccinated and either vaccinated patients, anti-Müllerian hormone levels were comparable (p = 0.139). The number of oocytes retrieved, fertilization rate and good-quality embryo rate were all similar between each group of in vitro fertilization and intracytoplasmic sperm injection. No significant differences were observed regarding other laboratory parameters. Moreover, the vaccination status of infertile couples did not exert any adverse effect on the pregnancy outcomes in all assisted reproductive technologies cycles. In short, we comprehensively evaluated the reproductive safety of inactivated severe acute respiratory syndrome coronavirus 2 vaccine and found any dose of vaccination wouldn't negatively affect female fertility parameters such as sex hormone levels and ovarian reserve. Moreover, this is the first study to complete the live birth follow-up of the cohort after receiving inactivated severe acute respiratory syndrome coronavirus 2 vaccine, further dispelling the misconception and providing reassurance for decision-making by clinicians.

Social media trust predicts lower COVID-19 vaccination rates and higher excess mortality over 2 years

Trust plays a crucial role in implementing public health interventions against the COVID-19 pandemic. We examined the prospective associations of interpersonal, institutional, and media trust with vaccination rates and excess mortality over time in two multinational studies. In study 1, we investigated the country-level relationships between interpersonal trust, vaccination rates, and excess mortality across 54 countries. Interpersonal trust at the country level was calculated by aggregating data of 80,317 participants from the World Values Survey in 2017-20. Data on vaccination rates and excess mortality were obtained from the World Health Organization. Our findings indicated that higher levels of interpersonal trust were linked to higher vaccination rates and lower excess mortality rates in both 2020 and 2021. In study 2, we collected data from 18,171 adults in 35 countries/societies, stratified by age, gender, and region of residence. At the country/society level, interpersonal trust and trust in local healthcare facilities, local healthcare services, and healthcare professionals were associated with higher vaccination rates and lower excess mortality, whereas social media trust was associated with lower vaccination rates and higher excess mortality across three time points over 2 years. Our findings are robust when controlling for country-level covariates of the government stringency index, population density, and medical resources (i.e. critical care beds) in both studies.

Who chooses alternative sources of information about childhood vaccinations? A cross-sectional study

Introduction

Vaccine hesitancy can lead to problematic outcomes in terms of public health. A factor playing a fundamental role in this dynamic is the source of information considered by parents in the decision-making progress that leads to the acceptance or refusal of childhood vaccinations. This study aims to investigate the sources of information considered by the parents of children attending primary and secondary schools in two large Italian cities and to identify predictors that led to choosing alternative sources of information.

Methods

An online questionnaire was administered to the parents of students attending elementary, middle, and high schools in Rome and Turin. Two validated tools were used: the Parent Attitudes about Childhood Vaccines Survey and the Vaccine Health Literacy of adults in Italian. Sources of information about vaccinations, trust toward the healthcare system, hesitancy and attitudes about COVID-19 vaccinations, were also investigated. A multivariable logistic regression model was built to identify predictors of the preferred sources of information on the topic.

Results

Totally, 2,301 answers to the survey were collected from June to October 2021. Of these, 1,127 came from parents in Rome (49%) and 1,174 from parents based in Turin (51%) with a mean age of 47.7 years (±6.4). The majority of the respondents were mothers (81%), married (73%), with two or more children (70.5%). The multivariable logistic regression model results showed that fathers were more inclined than mothers to use alternative sources of information (OR 1.48, 95% CI 1.29-2.00). Moreover, a higher level of vaccine hesitancy was a strong predictor for choosing alternative sources of information (OR 2.45, 95% CI 1.73-3.46). The HLVa-it scores show that parents with a lower Vaccine Literacy (VL) were more inclined to use alternative sources of information.

Discussion

Addressing health literacy issues and changing the official forms of communication could help improving vaccine acceptance. This study shows the importance of rebuilding a trusting relationship between patients and health care providers, which is fundamental in the fight against vaccine hesitancy.

Conspiracy Theories, Trust in Science, and Knowledge during the Third Wave of the COVID-19 Pandemic in Cyprus

Conspiracy theories flourish during periods of crisis. One way to counteract the believability of conspiracy theories is trust in science and knowledge about the "perceived threat", such as the SARS-CoV-2 virus. A total of 363 adults from Cyprus were recruited via convenience and snowball sampling methods. The data were collected via an internet-based questionnaire that examined participants' belief in 17 conspiracy theory statements, trust in science and scientists, knowledge about the symptoms and the spread of the SARS-CoV-2 virus, phobic anxiety, hostility, somatization, and personality traits based on the Big Five. The results suggest (a) the overall belief in conspiracy theories in Cyprus is low, even though a notable percentage holds a neutral stance towards these theories; (b) trust in science and knowledge about the symptoms and the spread of the SARS-CoV-2 virus is negatively related to conspiracy theories, indicating the importance of trusting science and having knowledge as a means to counteract conspiracy theories; (c) young adults, those residing in rural areas, and those with a low education level are more likely to believe in conspiracy theories; (d) there are no significant associations between conspiracy theories and the psychological dimensions of phobic anxiety, hostility, and somatization; (e) there is difficulty in identifying specific traits related to conspiracy ideation. Public health officials could benefit from the findings when communicating information during periods of crisis.

COVID-19 Vaccine Hesitancy in Cameroon: The Role of Medical Mistrust and Social Media Use

Most African countries report low COVID-19 vaccination rates (Msellati et al., 2022; WHO Africa; 2020). This study focuses on factors associated with vaccine hesitancy specifically in the country of Cameroon. Social media use and medical mistrust have been suggested as key variables that may increase vaccine hesitancy. Adopting the information-related perspective guided by the risk information seeking and processing model, the current research explored how social media use and medical mistrust are related to vaccine hesitancy among Cameroonians. Survey results from a sample of 1,000 Cameroonians fielded in early 2022 showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine. Belief in misinformation about the COVID-19 vaccine was negatively associated with perceived information insufficiency. A positive relationship between perceived information insufficiency and information seeking, as well as a negative relationship between information seeking and vaccine hesitancy were also found. Theoretical and practical implications are discussed.

Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, Arai K, Auwal SS, Bobes J, Bobes-Bascaran T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Cabrera Abud II, Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara C, Crepin P, de Berardis D, Zamora Delgado S, de Lucena D, de Sousa A, di Stefano R, Dodd S, Elek LP, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla P, Gonda X, Gondek TM, Morera González D, Gould H, Grandinetti P, Grau A, Groudeva V, Hagin M, Harada T, Hasan TM, Azreen Hashim N, Hilbig J, Hossain S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Ismayilova J, Jacobs A, Jakovljević M, Jakšić N, Javed A, Yilmaz Kafali H, Karia S, Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova E, Malik K, Iqbal Malik N, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Martinez S, Matiekus E, Mejia G, Memon RS, Meza Martínez XE, Mickevičiūtė D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto da Costa M, Popkov M, Popovic D, Raduan NJN, Vargas Ramírez F, Rancans E, Razali S, Rebok F, Rewekant A, Reyes Flores EN, Rivera-Encinas MT, Saiz PA, Sánchez de Carmona M, Saucedo Martínez D, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, Yashikhina A, Prezerakos PE, Berk M, Levaj S, Smirnova D. Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

INTRODUCTION

The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak.

MATERIALS AND METHODS

The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23).

CONCLUSIONS

The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study

People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.

Attitudes toward COVID-19 Vaccination: Staff and Patient Perspectives at Six Health Facilities in Sierra Leone

Sierra Leone is a West African country with a population of over 8 million. With more than half of Sierra Leone's population living in rural areas, it is important to understand rural populations' access to and attitudes toward the COVID-19 vaccine. In November 2021, the rate of vaccination coverage in Sierra Leone was only 7% for one dose and 4% for two doses. Understanding perspectives of health facility staff and patients can help strengthen future vaccine campaigns. We conducted a cross-sectional study, between March 2022 and May 2022, of clinical staff, non-clinical staff, and adult (>18 years) patients/caregivers attending six Ministry of Health and Sanitation (MoHS) facilities supported by Partners In Health, four in the Kono district and two in the Western Urban Area district, the capital of Sierra Leone. We assessed the opportunity to vaccinate, vaccine uptake, and intention to vaccinate. Out of the 2015 participants, 11.4% were clinical staff, 18.8% were non-clinical staff, and 69.8% were patients/caregivers. Less than half of the patients/caregivers had the opportunity to be vaccinated (42%), and 22% of patients/caregivers were fully vaccinated. Among the unvaccinated population, 44% would refuse a vaccine if offered to them at no cost. Lack of access to COVID-19 vaccines and to official education messaging, especially for patients and caregivers, is still an underlying problem in Sierra Leone for vaccine uptake, rather than a lack of willingness to be vaccinated.

COVID-19 Vaccine Hesitancy and Implications for Economic Recovery: Evidence from Nelson Mandela Bay Municipality in South Africa

The phenomenon of vaccine hesitancy is a growing threat to public health with far-reaching implications. The widening gap between the vaccinated and the proportion of vaccinated people needed for herd immunity raises two critical research questions that are of interest to practitioners, researchers, and policymakers: (1) What determines one's decision to be vaccinated? (2) What is the implication of COVID-19 vaccine hesitancy for economic recovery? In this study, we use empirical data in the context of South Africa to investigate factors affecting COVID-19 vaccine hesitancy and their implications for economic recovery. Findings reveal key socio-demographic and institutional drivers of COVID-19 vaccine hesitancy, which include age (the youth are more hesitant), inadequate information on the vaccine (those who perceive they have adequate information are vaccinated), trust issues in government institutions, conspiracy beliefs, vaccine-related factors, and perceived side effects associated with the vaccine. Additionally, an individual's decision to remain hesitant about COVID-19 vaccination has implications for businesses and the economy by limiting movement and trade, increasing unemployment, and causing a resurgence of new variants. Based on the findings, action plans such as information dissemination, convenience vaccination centers, consistent communications, and targeted campaign strategies are recommended for improving vaccine uptake and a positive economic recovery.

The impact of collective action dilemma on vaccine hesitancy: Evidence from China

Vaccine hesitancy has dramatically decreased the speed of vaccination and stalled global health development. While the factors influencing vaccine hesitancy and mitigation measures have been explored in depth by existing studies, research from the perspective of human interaction is lacking. Based on the theory of collective action, this paper analyzes how free riding behavior affects vaccine hesitancy and how the vaccine hesitancy caused by free riding behavior can be solved. Using 2,203 survey data sets from China, this paper examines the influence of the collective action dilemma - represented by free riding behavior - on COVID-19 vaccine hesitancy. The empirical results show that the existence of free riding behavior is an essential cause of vaccine hesitancy. Based on this conclusion, this paper discusses how to further alleviate the problem of vaccine hesitancy caused by collective action dilemmas by promoting cooperation. The findings of this paper may be helpful to promote various types of vaccines and further suggest that countries should assume the perspective of solving the collective action dilemma to achieve increased vaccination rates.

Trust and vaccine hesitancy during the COVID-19 pandemic: A cross-national analysis

Previous studies of vaccine hesitancy in the context of COVID-19 have reported mixed results in terms of the role played by political and institutional trust. This study addresses this ambiguity with a global analysis of the relationship between trust and vaccine hesitancy, disentangling the effects of generalized trust orientations, trust in specific institutions and conspiracy mentality. It first draws upon a cross-national survey of 113 countries to demonstrate that trust in government is a predictor of vaccine hesitancy across global regions. It further draws on original surveys fielded in seven countries (France, Germany, Spain, Argentina, Croatia, Brazil, India), which deploy a diverse range of measures, to disentangle the individual-level predictors of vaccine hesitancy. Our findings confirm the robust effects of trust in government across countries, but when including other trust measures in the same models, the most robust effects are those of trust in health institutions and conspiracy mentality. Weaker associations are observed for right-wing ideology and online political engagement, while the consumption of traditional media tends to predict the willingness of individuals to be vaccinated.

Why some people do not get vaccinated against COVID-19: Social-cognitive determinants of vaccination behavior

It is puzzling that a sizeable percentage of people refuse to get vaccinated against COVID-19. This study aimed to examine social psychological factors influencing their vaccine hesitancy. This longitudinal study traced a cohort of 2663 individuals in 25 countries from the time before COVID-19 vaccines became available (March 2020) to July 2021, when vaccination was widely available. Multilevel logistic regressions were used to examine determinants of actual COVID-19 vaccination behavior by July 2021, with country-level intercept as random effect. Of the 2663 participants, 2186 (82.1%) had been vaccinated by July 2021. Participants' attitude toward COVID-19 vaccines was the strongest predictor of both vaccination intention and subsequent vaccination behavior (p < .001). Perceived risk of getting infected and perceived personal disturbance of infection were also associated with higher likelihood of getting vaccinated (p < .001). However, religiosity, right-wing political orientation, conspiracy beliefs, and low trust in government regarding COVID-19 were negative predictors of vaccination intention and behavior (p < .05). Our findings highlight the importance of attitude toward COVID-19 vaccines and also suggest that certain life-long held convictions that predate the pandemic make people distrustful of their government and likely to accept conspiracy beliefs and therefore less likely to adopt the vaccination behavior.

Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study

BACKGROUND

COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult.

OBJECTIVE

This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations.

METHODS

The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models.

RESULTS

Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy.

CONCLUSIONS

The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy.

Psychometric validation of the Korean versions of the Vaccine Hesitancy Scale and Vaccination Attitudes Examination Scale

PURPOSE

Strategies for reducing vaccine hesitancy and negative attitudes toward vaccination and measures to accurately assess them have been developed worldwide. The Vaccine Hesitancy Scale (VHS) and Vaccination Attitudes Examination Scale (VAX) are reliable and valid tools. This study evaluates the validity and reliability of the Korean versions of the Vaccine Hesitancy Scale (K-VHS) and Vaccination Attitudes Examination Scale (K-VAX).

METHODS

We translated the VHS and VAX into Korean using forward and backward translations and tested their psychometric attributes. We collected data from a sample of 2,292 Koreans, recruited in June 2021 from a large online panel using quotas for age and gender. We used content validity, construct validity with confirmatory factor analysis, concurrent validity, and convergent validity to assess the validity of the scales, and tested their reliability with evaluations of internal consistency and stability.

RESULTS

The K-VHS and K-VAX showed good model fits in the validity tests, with seven items for one factor and 12 items for four factors, respectively. The internal consistency (Cronbach's alpha = 0.94 for the K-VHS, and 0.86 for the K-VAX) and stability (ICC = 0.86 for the K-VHS, and 0.88 for the K-VAX) of the measures indicated that they are reliable.

CONCLUSIONS

Both tools are effective psychometric instruments for assessing vaccine hesitancy and vaccination attitudes in Korean adults. K-VHS and K-VAX would be useful for predicting vaccination behaviors in novel infectious disease contexts and communicating the evidence needed to develop related policies or programs.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Conspiracy beliefs, COVID-19 vaccine uptake and adherence to public health interventions during the pandemic in Europe

BACKGROUND

Conspiracy beliefs can be a major hindrance causing a lack of compliance with public health measures, including vaccination. We examined the relationship between individual attitudes, socio-demographic factors, conspiracy beliefs, COVID-19 vaccine hesitancy and preferences about pandemic policies in Europe.

METHODS

We used data from the 10th round of the European Social Survey, conducted in 2021-22 in 17 European countries. Both a conspiracy index and a personal attitude index for each participant were built by using a Latent Class Analysis model. Then, we used a multilevel regression model to investigate the relationship between a personal attitudes index, socio-demographic factors and country of residence, and a conspiracy index. We descriptively analyse the relationship between the conspiracy index and four main items related to COVID-19.

RESULTS

We found that a higher probability of believing in conspiracy theories was associated with male gender, middle age, lower levels of education, unemployment, lower levels of trust and satisfaction and right-wing political orientation. The country of residence was a contextual factor, with eastern European countries having higher levels of conspiracy beliefs. Individuals who expressed conspiracy beliefs had lower COVID-19 vaccine uptake, were less satisfied with the way health services coped with the pandemic and less supportive of governmental restrictions.

CONCLUSIONS

This study provides valuable insights into the factors associated with conspiracy beliefs and their potential impact on public health. The findings highlight the need for effective strategies to address the underlying factors driving conspiracy beliefs, reduce vaccine hesitancy and promote acceptance of public health interventions.