A global survey of potential acceptance of a COVID-19 vaccine

The effectiveness of coercive measures in motivating vaccination: Evidence from China during the COVID-19 pandemic

Governments worldwide have implemented mandates, restrictions, and other coercive measures to secure adequate vaccine coverage, with the COVID-19 pandemic providing numerous examples. While the ethics and public reception of such measures are matters of heated discussion, their effectiveness in motivating individuals to get vaccinated remains incompletely understood. This study addresses that gap by analyzing data from a 2022 nationwide online survey conducted in China. Respondents recruited through proportional quota sampling to reflect key demographic characteristics of the population were asked to specify their COVID-19 vaccination status and the reason behind their decision. Results reveal that while most respondents reported getting vaccinated voluntarily, 14.6% attributed their vaccination to the government's coercive mobilisation efforts. Moreover, members of the ruling Chinese Communist Party, as well as individuals favouring Western vaccines unavailable in China, were more likely to cite coercive mobilisation as the reason for their vaccination. These findings suggest that coercive measures can motivate a substantial proportion of the population to get vaccinated, especially those closely connected to the political system and those with unmet vaccination preferences. Given the controversy surrounding such measures, this enhanced understanding of their effectiveness could help with formulating targeted policies to combat infectious diseases and safeguard public health.

COVID-19 vaccine knowledge and acceptance among the Libyan population: A cross-sectional study

We aim to identify Libyans' knowledge, attitudes, and acceptance regarding the COVID-19 vaccine. A cross-sectional survey was electronically distributed to the Libyan population aged 18 and older between May and September 2023. The questionnaire had three sections: socio-demographics, COVID-19 vaccination and infection, and knowledge and attitudes toward the COVID-19 vaccine. The chi-square test was used to assess the associations. A total of 1,043 respondents completed the questionnaire. Of these, 590 (56.6%) were vaccinated, and 453 (43.4%) were unvaccinated. Only age, educational level, employment status, history of COVID-19 infection, and source of information had a significant association with vaccination status; all shared a p-value <.05. However, Monthly income did not. Regarding knowledge, 63.7% agreed that vaccines in general are an effective way to prevent and control infectious diseases, and 76.6% agreed that they can prevent disease and mortality. However, regarding COVID-19 vaccine, 48.4% agreed that the benefits outweigh the risks. Regarding COVID-19 safety, 40.8% responded that COVID-19 vaccines are only slightly safe or not safe at all. COVID-19 vaccine acceptance was at 57.2%, and only age and source of information were significantly associated. Those who held favorable views were more likely to accept the vaccine, while those who had concerns about safety were more vaccine hesitant. There is a gap between the perception of the COVID-19 vaccine compared to other vaccines among Libyans. Our study revealed that 57.2% of Libyans accept the COVID-19 vaccine. However, only 34% of the Libyan population is vaccinated. A comprehensive health policy is needed.

A study on the willingness and influencing factors of non-EPI vaccines recommendations among Chinese vaccination staff under major infectious disease outbreaks

WHO had warned of the impending "X disease," emphasizing the need to quickly establish an immune barrier. The willingness of vaccination staff to recommend vaccines was crucial in such scenarios. This study aimed to investigate willingness and influencing factors of Non-EPI Vaccines recommendations among Chinese vaccination staff in Hangzhou, China. We selected vaccination staff in 191 vaccination clinics from Hangzhou for a questionnaire-based survey using a cross-sectional survey. Descriptive statistics were made on the characteristics of participants. Univariate and multivariable analyses were used to determine the influencing factors of Non-EPI Vaccines recommendations. The overall recommendation rate was 76.2%. Compared to Supplementary and Individual Non-EPI Vaccines, vaccination staff were more willing to recommend Alternative (x 2  = 215.655, P < 0.05) and Combined Non-EPI Vaccines (x 2  = 214.998, P < 0.05). Multivariate logistic regression analysis showed that vaccination staff who did not participate in COVID-19 vaccination work (OR = 2.942, 95%CI:1.121 ~ 9.302), believe they had an obligation to recommend Non-EPI Vaccines (OR disagree = 7.957, 95%CI:1.238 ~ 87.69; OR neutrality = 4.187, 95%CI:1.66 ~ 10.563), and think that the effects of non-routine immunization vaccines were very good (OR disagree = 3.133, 95%CI:1.677 ~ 14.495; OR neutrality = 2.512, 95%CI:1.164 ~ 5.418) were more willing to recommend Non-EPI Vaccines. On the contrary, vaccination staff who believe that recommending Non-EPI vaccines increased their workload (OR disagree = 0.307, 95%CI:0.11 ~ 0.856; OR neutrality = 0.642, 95%CI:0.258 ~ 0.986) would decrease willingness to recommend them. The most of vaccination staff were willing to recommend non-EPI vaccines under major infectious disease outbreaks. To further control the pandemic of major infectious diseases, the health management departments should enhance the knowledge of vaccines among vaccination staff and alleviate their workload.

Unravelling disparity in age-specific acceptance of COVID-19 vaccination: the contextual and psychosocial influences

BACKGROUND

High COVID-19 vaccination uptake rates across all age groups are important for achieving herd immunity. However, age disparity in vaccination acceptance was consistently identified.

OBJECTIVE

Taking cues from tenets of socioemotional selectivity theory, this study examined how the contextual and psychosocial factors contributed to age-specific COVID-19 vaccination acceptance.

METHOD

Four rounds of population-based cross-sectional surveys were conducted before and after the COVID-19 vaccination programme started in Hong Kong (n = 3527). Participants' vaccination acceptance, trust in government, social norms, vaccine confidence and risk perception of COVID-19 were obtained. Vaccine-related news headlines were collected in the same timeframe.

RESULT

Sentiment analysis found that the impact of negative news sentiment on vaccine hesitancy was greater among older people. The path analyses found that older people had greater trust in government, perceived greater influence of social norms, and had greater vaccine confidence which all in turn were associated with greater vaccination acceptance. However, older people were found to have less worry about contracting COVID-19, which somewhat lowered their vaccination acceptance.

CONCLUSION

Communication to promote older people's vaccination uptake should focus on promoting the government's timely response to the negative news reports about vaccines and increasing the positive influences of social norms on their vaccination acceptance.

Global spatio-temporal distribution of coronavirus disease 2019 vaccine hesitancy between 2020 and 2022: A meta-analysis

OBJECTIVE

Vaccine hesitancy is a major barrier to high coronavirus disease 2019 (COVID-19) vaccine coverage. To synthesize global research on COVID-19 vaccine hesitancy, a meta-analysis was conducted to provide scientific evidence for understanding its spatial and temporal variations and influencing factors.

METHODS

We searched the PubMed, Web of Science, and Embase databases for studies published in English between January 2020 and December 2023 and included cross-sectional and cohort studies with study populations that included the general adult population aged ≥18 years and provided quantitative data on COVID-19 vaccine acceptance or hesitancy. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis elements and guidance for abstracting and assessing data quality and validity. Two groups of investigators independently extracted the study characteristics, including the outcome variable (the vaccine hesitancy rate). Our meta-analysis used a random-effects model. The outcome of interest was COVID-19 vaccine hesitancy. The included studies were divided into two categories based on their definitions of COVID-19 vaccine hesitancy. Definition 1 combined vaccination behavior and willingness, and Definition 2 was based solely on willingness to vaccinate.

RESULTS

855 studies were included in the final analytical dataset; 121 met Definition 1, and 734 met Definition 2. There were 277,285,178 participants in the included studies. In studies meeting Definition 1, hesitancy rates increased annually: 18.8 % in 2020, 29.1 % in 2021, and 30.8 % in 2022. However, in studies that met Definition 2, the hesitancy rates remained at 35 %. African studies reported the highest hesitancy rates globally (42.0 %), whereas European studies reported the lowest (16.5 %). Furthermore, there was a temporal association between mortality trends and COVID-19 hesitancy because the monthly cumulative death peaks coincided with lower hesitancy peaks.

CONCLUSION

COVID-19 vaccine hesitancy increased across the continent during 2020-2022 and might be influenced by misinformation, policy changes, and public fatigue. Demographic factors like age, gender, and education also play a key role in vaccine hesitancy. The link between vaccine hesitancy and pandemic severity highlights the need for timely and effective public health responses.

Trust in official information as a key predictor of COVID-19 vaccine acceptance: evidence from a Czech longitudinal survey study

BACKGROUND

COVID-19 vaccine hesitancy (CVH) has become a critical public health issue, with attitudes toward vaccines emerging as a broader social issue. Public debates surrounding vaccines have expanded beyond health considerations to include issues of trust, misinformation, and societal values, making CVH a complex challenge that requires multifaceted solutions. Analyzing the various determinants of CVH is crucial for developing targeted strategies to improve vaccine acceptance in specific countries and to better prepare for future public health crises. However, no study to date has evaluated the determinants of CVH in a representative sample of the Czech population.

METHODS

A multiple hierarchical logistic regression was used to analyze the associations between various sociodemographic, trust and attitudinal factors with COVID-19 vaccine acceptance (CVA). The analysis utilized survey data from a representative longitudinal sample of the Czech population (N = 1,407).

RESULTS

After controlling for all other factors, trust in official statements from the Ministry of Health was the strongest predictor of CVA, followed by prior positive attitudes toward COVID-19 vaccination (prior to vaccine availability) and older age. Lower trust in COVID-19 misinformation also predicted CVA, while lower interest in COVID-19 media content was associated with CVA. Higher income initially predicted CVA but lost statistical significance after controlling for other variables. Interestingly, education did not play a role in CVA.

CONCLUSION

CVH was primarily driven by distrust in government-provided information. Notably, vaccine refusers demonstrated a higher motivation to seek information on the topic, offering a promising opportunity for health policy interventions. Our findings suggest that strategies to reduce CVH should prioritize building trust in state institutions and effectively combating misinformation.

Identifying vaccine-hesitant subgroups in the Western Pacific using latent class analysis

Vaccine hesitancy seriously compromised the COVID-19 vaccine roll-out across the Western Pacific with limited evidence-based recommendations for diverse populations across the region. This study investigates the profile of the vaccine-hesitant populations by using fixed-effect latent class analysis and multi-country survey data collected in 12 countries in 2021 and 2022: Cambodia, Viet Nam, Lao PDR, Japan, Republic of Korea, Malaysia, Philippines, Mongolia, Fiji, Solomon Islands, Tonga and Vanuatu. The analysis identified 9 latent classes: Stay-at-home mothers, High-school-educated employees, High-school-educated older adults, High-school-educated young adults, University-educated employees, University-educated older adults, University-educated young adults, Unemployed, Non-compliant employees. The probabilities of COVID-19 vaccine acceptance and booster uptake were significantly lower in most of these latent classes, compared to University-educated older adults, as the reference group. While each country had unique compositions of latent classes among vaccine-hesitant people, there were also some shared risk groups, such as High-school-educated employees and High-school-educated young adults, across the countries. The study findings demonstrate the benefits of subgroup analysis in unpacking the complex interplay of characteristics within vaccine-hesitant populations, highlighting the need for customised strategies tailored to each country's unique profile of vaccine hesitancy.

How People in Eight European Countries Felt About the Safety, Effectiveness, and Necessity of COVID-19 Vaccination: A Cross-Sectional Survey

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. The secondary outcomes focused on how respondents' views were affected by demographic and context factors and included a comparison by country of the level of feeling well informed. Methods: A mixed-method cross-sectional online survey in eight European countries, using convenience sampling. Results: A total of 1008 adults completed the survey, 60% of whom were female. While only 44.1% considered the vaccines safe, 43.5% effective, and 44.9% necessary, 80.0% had been vaccinated. Four in ten adults strongly agreed that they were well informed, while over a quarter did not answer the question. Younger respondents, well-informed individuals, and German respondents were more inclined to perceive COVID-19 vaccination as both effective and necessary. Conclusions: Motivations for vaccination included perceived health and social benefits, while concerns included a preference for "natural immunity", the rapid development of the vaccine, and potential unknown long-term effects. A correlation existed between respondents feeling well informed about the different COVID-19 vaccines in their country and the likelihood of having been vaccinated.

Are we ready for the next pandemic? Public preferences and trade-offs between vaccine characteristics and societal restrictions across 21 countries

In vaccination decisions, individuals must weigh the benefits against the risks of remaining unvaccinated and potentially facing social restrictions. Previous studies have focused on individual preferences for vaccine characteristics and societal restrictions separately. This study aims to quantify public preferences and the potential trade-offs between vaccine characteristics and societal restrictions, including lockdowns and vaccine mandates, in the context of a future pandemic. We conducted a discrete choice experiment (DCE) involving 47,114 respondents from 21 countries between July 2022 and June 2023 through an online panel. Participants were presented with choices between two hypothetical vaccination programs and an option to opt-out. A latent class logit model was used to estimate trade-offs among attributes. Despite some level of preference heterogeneity across countries and respondents' profiles, we consistently identified three classes of respondents: vaccine refusers, vaccine-hesitant, and pro-vaccine individuals. Vaccine attributes were generally deemed more important than societal restriction attributes. We detected strong preferences for the highest levels of vaccine effectiveness and for domestically produced vaccines across most countries. Being fully vaccinated against COVID-19 was the strongest predictor of pro-vaccine class preferences. Women and younger people were more likely to be vaccine refusers compared to men and older individuals. In some countries, vaccine hesitancy and refusal were linked to lower socioeconomic status, whereas in others, individuals with higher education and higher income were more likely to exhibit hesitancy. Our findings emphasize the need for tailored vaccination programs that consider local contexts and demographics. Building trust in national regulatory authorities and international organizations through targeted communication, along with investing in domestic production facilities, can improve vaccine uptake and enhance public health responses in the future.

Factors influencing nurses and nursing students' attitudes towards vaccinations: A cross-sectional study

BACKGROUND

Vaccination hesitancy remains the main obstacle to improving vaccination coverage. Influenza and COVID-19 vaccination coverage among healthcare professionals is essential. It is crucial to study the vaccination attitudes of healthcare professionals as they significantly influence the vaccination attitudes and behaviour of the rest of the population.

OBJECTIVE

The aim of this study was to describe the attitudes of Finnish nurses and nursing students towards COVID-19 and Influenza vaccination and explain what factors influence these attitudes.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A total of 1353 nurses from five hospital organisations and 580 nursing students from eight Universities of Applied Sciences participated in the survey. Participants were invited to complete the questionnaire through Webropol between March and September 2023.

METHODS

To collect data anonymously, a self-reported web-based questionnaire combining the Vaccination Attitude Examination (VAX) scale and Bergen's Social Media Addiction (BSMA) scale was used. K-means cluster analysis was performed to describe vaccination attitude profiles.

RESULTS

Four distinct vaccination attitude profiles were identified: Profile A - Confident Pro-Vaccine (n = 605) exhibited low hesitancy, with high confidence in vaccine safety and effectiveness; Profile B - Cautiously Pro-Vaccine (n = 764) showed moderate hesitancy, mainly concerned about unforeseen future effects; Profile C - Hesitant with Mistrust (n = 405) expressed high hesitancy, with significant worries about vaccine safety and mistrust in health authorities; and Profile D - Strongly Vaccine-Hesitant (n = 159) demonstrated very high hesitancy, marked by strong beliefs in potential long-term negative effects of vaccination. Significant differences in VAX-scale mean scores were found between the profiles, ranging from 1.27 for Profile A to 6.65 for Profile D. Overall, nursing students were more hesitant than practising nurses, with students being overrepresented in the more hesitant profiles. Clinical training in a COVID-19 unit was associated with more favourable vaccination attitudes among nursing students. The uptake of the full series of COVID-19 and annual Influenza vaccines was generally high in the sample (90.8 % and 87 %, respectively). However, a clear pattern between specific social media use and vaccination attitudes was not found. Major concerns related to vaccine hesitancy focused on the uncertainty of vaccines' long-term effects.

CONCLUSION

This study provides valuable insights into the complex nature of vaccination hesitancy among nurses and nursing students. These findings underscore the need for targeted interventions to address underlying concerns and promote vaccine acceptance within this demographic. In future research, it would be essential to gather more in-depth knowledge, particularly regarding nursing students' attitudes towards vaccination and the factors influencing them.

COVID-19 vaccine acceptance among kidney transplant recipients in Singapore

INTRODUCTION

A successful vaccination programme forms the cornerstone of controlling coronavirus disease 2019 (COVID-19). The unprecedented speed of COVID-19 vaccine development and lack of long-term data have raised fears regarding its safety and efficacy. Vaccine hesitancy can undermine the uptake, and hence success of the vaccination programme. Given the high complication rates of COVID-19 infections in kidney transplant recipients, it is particularly important to identify and address vaccine hesitancy in this population.

METHODS

We conducted a cross-sectional survey among kidney transplant recipients attending transplant clinic between 5 April and 5 May 2021. The survey assessed attitudes towards COVID-19, willingness/hesitancy towards COVID-19 vaccination, vaccination concerns and prompts to vaccination. This was scored on a Likert scale with scores ranging from 'strongly disagree' - 1 point to 'strongly agree' - 5 points.

RESULTS

One hundred and one completed responses were captured. Of these, 86% respondents reported to agree or strongly agree to vaccination. This was despite significant concerns of allograft rejection (mean score 4.12, standard deviation [SD] 0.97) and decreased immunosuppressant efficacy (mean score 4.14, SD 0.96) with vaccination. Multivariable model showed a positive association with transplant vintage of ≥ 5 years (median 2.41), lower educational levels of secondary school or less (median 5.82) and healthcare provider advocacy (median 1.88) in predicting vaccine acceptance.

CONCLUSIONS

Vaccine acceptance rate was high among kidney transplant recipients. Vaccine hesitancy remains a concern in those with a transplant vintage of less than 5 years and those with tertiary educational level. Healthcare provider advocacy is important in improving vaccine acceptance rates.

Mpox vaccination hesitancy, previous immunisation coverage, and vaccination readiness in the African region: a multinational survey

Background

Vaccination hesitancy poses a serious threat to mpox vaccination programs. Historically, vaccine uptake in the African region has been low, and this trend may impact future vaccination efforts. Our aim was to investigate the relationships between mpox vaccination hesitancy, immunisation coverage for other vaccines, and vaccination readiness among African adults.

Methods

A multinational commercial web panel survey was conducted among 1832 African adults across six countries (Uganda, Nigeria, Morocco, Egypt, Kenya, and South Africa) from October 1 to October 10, 2024. Mpox vaccination hesitancy for themselves and children was defined as the reluctance to receive vaccines against mpox (if vaccines were available) for themselves and for children (if they had children). Vaccination readiness was assessed via the 7Cs model, which includes confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy. Weighted logistic regression models with the set of calibration sampling weights were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). The analysis explored the effects of immunisation coverage for other vaccines and vaccination readiness on hesitancy toward mpox vaccination, including mediation and joint relationships. DerSimonian-Laird random-effects meta-analyses were utilised to pool the results from six countries.

Findings

The pooled weighted rate of mpox vaccination hesitancy among participants was 32.7% (95% CI: 25.4-40.0, I 2  = 91.5%, p < 0.0001) for themselves and 38.9% (95% CI 30.2-47.6, I 2  = 93.7%, p < 0.0001) for children. After adjusting for covariates, the absence of immunisation coverage for other vaccines independently increased the risk of mpox vaccination hesitancy for themselves and for children, with a pooled OR of 2.66 (95% CI 1.67-4.26, I 2  = 25.8%, p = 0.241) and a pooled OR of 2.16 (95% CI 1.42-3.30, I 2  = 0%, p = 0.471), respectively. The pooled mediation proportions of vaccination readiness for the relationship between immunisation coverage for other vaccines and mpox vaccination hesitancy were 15.85% (95% CI 0.64-31.06, I 2  = 60.9%, p = 0.703) and 52.53% (95% CI 20.93-84.14, I 2  = 0%, p = 0.988) for themselves and for children, respectively. The pooled weighted rate of mpox vaccination hesitancy was highest among individuals with low vaccination readiness and no history of other vaccinations, with a pooled weighted rate of 62.7% (95% CI 44.7-80.7, I 2  = 82.8%, p < 0.0001) for themselves and 76.3% (95% CI 66.9-85.7, I 2  = 40.6%, p = 0.135) for children. Compared with the reference group (high vaccination readiness and a history of other vaccinations), populations that reported low vaccination readiness and no history of other vaccinations exhibited the highest risk of mpox vaccination hesitancy for themselves (pooled OR 7.83, 95% CI 3.28-18.70, I 2  = 63.2%, p = 0.018) and for children (pooled OR 12.55, 95% CI 7.38-21.33, I 2  = 0%, p = 0.585), followed by populations that reported low vaccination readiness and a history of other vaccinations (pooled OR for themselves 2.69, 95% CI 1.70-4.26, I 2  = 66.7%, p = 0.01; pooled OR for children 4.97, 95% CI 3.66-6.74, I 2  = 19.6%, p = 0.286). However, populations that reported high vaccination readiness and no history of other vaccinations demonstrated a higher risk of mpox vaccination hesitancy for themselves (pooled OR 2.28 95% CI 1.05-4.94, I 2  = 0%, p = 0.608), but not for children.

Interpretation

Our findings indicate a significant level of hesitancy toward mpox vaccination in the African region. Individuals who have not previously received other vaccines are at a higher risk of refusing to vaccinate against mpox for themselves and for children. However, high vaccination readiness can help mitigate this risk. The study recommends that regions in Africa with low immunisation coverage should continue to enhance vaccination education and improve vaccination readiness to reduce hesitancy and promote the mpox vaccination program.

Funding

This work was partly supported by the National Natural Science Foundation of China (grant numbers 72122001, 72474005).

Does delivery matter? Examining pandemic vaccination preferences across time and countries using a discrete choice experiment

INTRODUCTION

After a pandemic outbreak, designing and implementing an effective vaccine supply chain is key. The last-mile vaccine delivery (LMVD) - the last stage of the vaccine supply chain - is of particular importance. LMVD design choices, such as the delivery mode (e.g., mobile team or PODs) and the number and locations of PODs, affect "operational attributes" like travel time and waiting time. This paper aims to understand how operational attributes of LMVD systems impact vaccination preferences across different priority groups, pandemic stages, and countries.

METHODS

Adults in The Netherlands (N=473 in May 2021 and N=385 in January 2023), Italy (N=302 in March 2023), and Poland (N=303 in March 2023) completed an online discrete-choice experiment. Participants chose between two hypothetical LMVD systems (and opt-out) with five attributes: appointment flexibility, appointment delay, in-facility waiting time, travel time, and familiarity with personnel. Mixed logit models were used to estimate coefficients, based on which relative importance (RI) and vaccine uptake percentages were calculated.

RESULTS

Operational attributes have a significant impact on estimated uptake. Travel time was the most important attribute in all four studies. Appointment delay and in-facility waiting consistently ranked second or third. The impact of the choice of an LMVD system on uptake varies over time and by country. In The Netherlands, it was strong in 2023 (23.4%) but moderate in 2021 (12.6%). Similarly, it was strong in Italy 2023 (21.8%) and moderate in Poland 2023 (11.4%). The estimated impact also varied by priority group, and was minor (6.1%) for the elderly with poor health in The Netherlands 2021 study.

CONCLUSION

Design choices for the LMVD system significantly impact vaccination preferences. Adapting these systems to different countries, time periods, and population groups is key for their effectiveness.

Social factors influencing behavioral intentions to vaccinate: personality traits and cues to action

Objectives

This study integrates the Five-Factor Model (FFM) of personality traits with the Health Belief Model (HBM) to examine associations among personality traits, cues to action, and vaccination intentions.

Method

An online survey was conducted in April 2021, with 2,098 participants (mean age = 31.22 years, SD = 8.29) completing the study. The questionnaire assessed HBM constructs and the FFM personality traits. Spearman correlation coefficients were used to evaluate associations among ordinal variables, while Structural Equation Modeling (SEM) explored complex relationships between latent variables.

Results

The findings indicate that self-efficacy (β = 0.198) and perceived barriers (β = 0.515) exert the most significant direct positive influences on vaccination intentions. Cues to action, particularly recommendations from family members (β = 0.113) and doctors (β = 0.092), also significantly affect vaccination intentions. Notably, personality traits indirectly influence vaccination intentions through self-efficacy and perceived barriers. Furthermore, agreeableness most significantly affects family suggestions, while neuroticism strongly influences recommendations from authority figures and healthcare providers, with extraversion notably impacting suggestions from peers.

Conclusions

The study highlights the influence of personality traits on cues to action, with neuroticism linked to authority influence, extraversion to peer influence, and agreeableness to familial influence. These findings emphasize the importance of incorporating individual differences into public health policies and vaccination promotion strategies. Future research should further explore the effects of diverse personality traits and community-specific profiles on vaccination behaviors to enhance intervention effectiveness.

High coverage and equitable distribution of COVID-19 vaccine uptake in two vulnerable areas in Bangladesh

Bangladesh completed a primary series of COVID-19 vaccinations for about 86 individuals per 100 population as of 5 July 2023. However, ensuring higher coverage in vulnerable areas is challenging. We report on the COVID-19 vaccine uptake and associated factors among adults in two vulnerable areas in Bangladesh. We conducted a cross-sectional study between August and September 2022 in Duaripara, a slum in northeast Dhaka (in-migration site), and Tala, a disaster-prone sub-district in southwest Satkhira (out-migration site). We surveyed 1,239 adults in Duaripara and 1,263 adults in Tala from 625 and 596 randomly selected households, respectively. We reported coverage and examined associations between the uptake and demographic and socioeconomic characteristics using multilevel mixed-effects generalized linear regression models. We checked for spatial autocorrelation to assess geographical patterns in vaccine distribution. First- and second-dose coverage was about 91% and 80.4% in Duaripara and 96.6% and 92.2% in Tala, respectively. Individuals above 40 were more likely to be vaccinated (IRR: 1.12, p-value = 0.04 for Duaripara, and IRR: 1.14, p-value <0.01 for Tala). Professions requiring more outdoor interactions had a higher likelihood of receiving the vaccine. In Tala, television access (IRR: 2.09, p-value <0.01) and micro-credit membership (IRR: 1.50, p-value = 0.05) were positively associated with receiving a booster dose and negatively associated with smart-phone access (IRR: 0.58, p-value = 0.03). Moreover, temporarily migrated respondents were more likely to be unvaccinated (IRR: 0.87, p-value = 0.04). Income was not associated, indicating equitable distribution. Moreover, no geographical clustering was detected. The credit for high COVID-19 vaccine coverage in Bangladesh can be attributed to the country's longstanding success in implementing immunization programs, which relied on community mobilization and effective health education to generate demand. However, to ensure comprehensive coverage in vulnerable areas, targeted interventions can help increase uptake by addressing specific sociodemographic differences.

Optimizing vaccine uptake in sub-Saharan Africa: a collaborative COVID-19 vaccination campaign in Madagascar using an adaptive approach

BACKGROUND

The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar.

METHODS

Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked.

RESULTS

Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished.

CONCLUSIONS

Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19.

Willingness to receive COVID-19 vaccine and associated factors among teachers in Dambi Dollo, Ethiopia: a cross-sectional study

BACKGROUND

Teachers play important roles in influencing vaccine uptake decisions and should serve as examples for their students by willingly getting vaccinated. Given the low vaccination rates in this area, it is crucial to explore teachers' willingness to get vaccinated and emphasize their role in promoting vaccine acceptance.

OBJECTIVE

The main objective of this study was to assess the willingness of teachers to receive the COVID-19 vaccine and its associated factors in Dambi Dollo town.

METHODS

A school-based cross-sectional study was conducted from February 1 to March 30, 2022. Data were collected using a self-administered questionnaire and analysed with SPSS version 23.0. The dependent variable was willingness to receive the COVID-19 vaccine. Variables that showed an association with the dependent variable in the bivariable analyses at a p-value of 0.25 were entered into a multiple stepwise logistic regression model. A p- value of 0.05 was considered statistically significant in this study's multivariable analysis to determine the presence of significant association between the dependent and the independent variables. Adjusted Odds ratios, along with the corresponding 95% confidence intervals were used to interpret the findings.

RESULTS

A total of 247 teachers participated in this study. About 92% of the teachers in Dambi Dollo town have heard COVID-19 vaccine and 67.2% of them knew that the vaccine can prevent the COVID-19 disease. On the other hand, 51% (95%CI: 44.8, 57.2) of the respondents had good knowledge about the COVID-19 vaccine. From the total 247 participants, 68.4% (95%CI: 62.5, 74.3) were willing to receive the vaccine immediately while the remaining were either not willing or not ready at the time of data collection. Those participants having good knowledge of the vaccine were about six times more willing to get vaccinated (AOR = 5.85, 95%CI: 2.74, 12.47) in comparison with those having poor knowledge.

CONCLUSION

In conclusion, the level of willingness to receive the COVID-19 vaccine among school teachers in Dambi Dollo town was 68.4. Followers of Protestant religion and Muslims were less willing compared with Orthodox Christians while the participants with good knowledge were more willing to be vaccinated.

How text message reminders increase COVID-19 booster vaccine uptake: Two randomized controlled trials

BACKGROUND

Vaccines are effective and affordable health prevention measures to prevent vaccine-preventable diseases, but achieving sufficient vaccine uptake population-wide is challenging. In this work, we assess the impact of various text messages reminders on COVID-19 booster uptake and the extent to which the effect of messages holds over time. Additionally, we analyse whether people's self-reported vaccination intentions (measured in response to message prompts) corresponds to actual vaccine uptake and whether this relationship differs between message variants.

METHODS

We performed two large sequential randomized controlled trials (RCTs) in the Netherlands (N = 140.973), with the design of RCT2 building on the findings of RCT1. We 1) analyzed the effect of various text messages on COVID-19 booster uptake; 2) assessed the extent to which these effects hold over time; and 3) tested whether a positive response to message prompts moderates the effect of message variant on vaccine uptake.

RESULTS

First, the results of RCT1 demonstrate that text messages with an ownership frame ("your [vaccine] is ready for you") result in highest vaccine uptake (e.g., compared to no text message: OR = 1.28 [99 % CI 1.03-1.59]). RCT2 showed that text messages with an ownership frame and a specific date, time and location result in highest vaccine uptake (e.g., compared to no text message: OR = 2.10 [99 % CI 1.85-2.38]). Second, most message effects hold over a longer period of time (e.g., 'date, time, location' message versus no message: OR = 2.10 [99 % CI 1.85-2.38] on day 6 and OR = 1.36 [99 % CI 1.25-1.48] on day 50). Third, we find that participants who received our most effective text and replied that they will take the vaccine, are more inclined to actually take the vaccine compared to the message with broad opening hours OR = 2.86 [99 % CI 2.14-3.82].

CONCLUSION

Text message reminders are able to increase vaccine uptake. From the tested variations, messages with an ownership frame providing a specific date, time and location are most effective. Because text messages demonstrate no notable disadvantages, we advise Public Health authorities to include this effective intervention in their vaccination campaign strategies.

COVID-19 vaccine acceptance and 5C psychological antecedents amid the omicron surge in South Korea and China

BACKGROUND

It is crucial to emphasize the necessity of annual COVID-19 vaccination, particularly for vulnerable populations like older and chronically ill individuals.

OBJECTIVES

This study aimed to quantify the level of vaccination acceptance and its 5C psychological antecedents in the South Korean and Chinese populations and also to identify the predictors, considering contextual variations that influence vaccine acceptance in both countries.

METHODS

A cross-sectional survey study was undertaken in South Korea and China between March 15 and March 30, 2023, coinciding with the emergence of the SARS-CoV-2 Omicron variant in both nations. The study comprised 1000 participants from South Korea and 3000 participants from China. A chi-square analysis, t-tests and multivariable logistic regression analysis were employed to evaluate the factors influencing the acceptance of COVID-19 vaccines.

RESULTS

A higher degree of vaccine acceptance was observed among Chinese participants (48.5 %), in contrast to the 16.8 % among South Koreans. Analyzing the psychological antecedents for vaccination, the Chinese cohort showed high vaccine confidence, whereas South Koreans had increased constraint perceptions. Psychological antecedents, particularly Confidence, play a significant positive role in vaccine acceptance in both South Korea (OR 2.98, CI [2.26-4.01], p < 0.001) and China (OR 2.93, CI [2.58-3.33], p < 0.001), while Constraints in South Korea (OR 0.83, CI [0.69-0.99], p < 0.05) and China (OR 0.86, CI [0.79-0.94], p < 0.001) contribute negatively to vaccine acceptance. Notably, divergent trends in the impact of age and underlying health conditions on vaccine acceptance were observed.

CONCLUSIONS

This study reveals a substantial disparity in acceptance, psychological antecedents, and predictors of vaccine acceptance between China and South Korea. This importance of understanding contextual factors influencing public vaccine acceptance is emphasized. There is an urgent need for robust vaccination strategies that boost confidence and alleviate constraints to COVID-19 vaccination, which should be tailored to the unique contextual factors of each country.

Understanding COVID-19 Vaccine Hesitancy among the General Population in Japan from Public Health Ethical Perspectives: Findings from a Narrative Review

Japan has been reported as a country with high levels of vaccine hesitancy. However, a lack of comprehensive reviews studying factors for vaccine hesitancy for the COVID-19 vaccines in the Japanese context from the perspective of ethical controversy exists. Using a narrative review method, we reviewed factors associated with vaccine hesitancy to the COVID-19 vaccines and examined issues related to ethical controversy among the Japanese population. Factors associated with vaccine hesitancy include concerns about vaccine safety, suspicion of vaccine inefficacy, mistrust of the government, and low perceived threat. Factors associated with vaccine acceptance include environmental factors, factors related to Japanese cultural values, including collectivism and social norms, and positive attitudes toward information provided by authorities. Unique backgrounds in Japan are historical events such as the anti-HPV vaccine campaigns, the accessible medical system fostering high expectations of zero risk, and cultural factors of caring social norms influencing vaccine acceptance. Ethical controversies arise from preferences and practices at the individual or national level around individual rights versus public health benefits. Healthcare professionals and public health experts should continue dialoguing with the critical mass, practitioners, and policymakers, considering the ethical dilemmas surrounding individual rights and public health benefits. Insights obtained from this study indicate the need to develop tailored strategies to enhance vaccine acceptance while respecting individual autonomy within the Japanese context.

Perceptions about respiratory syncytial virus (RSV) and attitudes toward the RSV vaccine among the general public in China: A cross-sectional survey

Our study aims to assess the public's perceptions of respiratory syncytial virus (RSV) and attitudes toward the RSV vaccine and to identify associated factors in China. A nationwide cross-sectional survey conducted using an online platform between August 16 and September 14, 2023. Questions related to socio-demographics, awareness, knowledge, perceptions of susceptibility and severity of RSV, and attitudes toward the RSV vaccine were included in the questionnaire. We used the chi-square test and logistic regression model to explore the associated factors. Overall, 2133 individuals were included in this study. Nearly a quarter of participants (24.3%) indicated that they had never heard of RSV. The proportion of individuals aged over 50 years reporting never having heard of RSV (36.5%) and having a low knowledge level of RSV (55.3%) was significantly higher that of other younger age groups. More than half of individuals (55.7%) exhibited low level of perceptions of susceptibility concerning RSV infection. A total of 68.4% of the participants expressed willingness to receive the RSV vaccine. Younger age was positively associated with a higher willingness to be vaccinated. The most frequent reason for declining the vaccine was "Concern about vaccine's safety or side effects." About 60% of individuals considered a price of RSV vaccine below 200 CNY (28 USD) as acceptable. The awareness and perceived susceptibility to RSV infection were limited to the Chinese public. It is necessary to take measures to address the low awareness and knowledge of RSV and acceptability of the RSV vaccine among older adults.

How urban versus rural population relates to COVID-19 booster vaccine hesitancy: A propensity score matching design study

During the COVID-19 pandemic, the vaccine hesitancy has significantly affected the vaccination. To evaluate the booster vaccine hesitancy and its influencing factors among urban and rural residents, as well as to estimate the net difference of booster vaccine hesitancy between urban and rural residents. We conducted a nationwide, cross-sectional Internet survey on 1-8 February 2023, and employed stratified random sampling technique to select participants (≥18 years old) from urban and rural areas. Multivariate logistic regression was used to determine the factors impacting booster vaccine hesitancy. Propensity Score Matching was used to estimate the net difference of COVID-19 booster vaccine hesitancy between urban and rural residents. The overall COVID-19 booster vaccine hesitancy rate of residents was 28.43%. The COVID-19 booster vaccine hesitancy rate among urban residents was found to be 34.70%, among rural residents was 20.25%. Chronic diseases, infection status, vaccination benefits, and trust in vaccine developers were associated with booster vaccine hesitancy among urban residents. Barriers of vaccination were associated with booster vaccine hesitancy among rural residents. PSM analysis showed that the urban residents have a higher booster vaccine hesitancy rate than rural residents, with a net difference of 6.20%. The vaccine hesitancy rate increased significantly, and the urban residents have a higher COVID-19 booster vaccine hesitancy than rural residents. It becomes crucial to enhance the dissemination of information regarding the advantages of vaccination and foster greater trust among urban residents toward the healthcare system.

Exploring vaccine hesitancy and acceptance in the general population of Pakistan: Insights into COVID-19-related distress, risk perception, and stigma

The coronavirus disease 2019 (COVID-19) caused several impacts. Focusing on 360 participants (178 males, 182 females), this study explored the association between COVID-19 related distress, risk perception, stigma, and vaccine hesitancy and acceptance in the general population. Measures used included the Hospital Anxiety and Depression Scale (HADS) and COVID Stress Scale (CSS) to evaluate anxiety, depression, and COVID-19 related distress, the COVID-19 Risk Perception Scale and COVID-19 Stigma Discrimination Scale to assess risk perception and stigma, and the Oxford COVID-19 Vaccine Hesitancy Scale and Vaccine Acceptance Instrument to measure vaccine hesitancy and acceptance. The findings revealed that 66.9% of participants exhibited vaccine hesitancy, and stress and risk perception were significant predictors of both vaccine hesitancy and acceptance, even after controlling for demographic factors. This study highlights the importance of understanding the factors mentioned above that will contribute to vaccine hesitancy and acceptance, which will contribute to promoting vaccine acceptance.

Knowledge about, attitudes toward and acceptance and predictors of intention to receive the mpox vaccine among cancer patients in China: A cross-sectional survey

This study aimed to investigate the knowledge about, attitudes toward, and acceptance and predictors of receiving the mpox vaccine among Chinese cancer patients. Patients were selected using a convenience sampling method. A web-based self-report questionnaire was developed to assess cancer patients' knowledge, attitudes, and acceptance regarding the mpox vaccine. Multivariate logistic regression analysis was used to determine predictors of acceptance of the mpox vaccine. A total of 805 cancer patients were included in this study, with a vaccine hesitancy rate of 27.08%. Approximately 66% of the patients' information about mpox and the vaccine came from the mass media, and there was a significant bias in the hesitant group's knowledge about mpox and the vaccine. Multivariable logistic regression analysis suggested that retirement; chemotherapy; the belief that the mpox vaccine could prevent disease, that vaccination should be compulsory when appropriate and that the mpox vaccine prevents mpox and reduces complications; the willingness to pay for the mpox vaccine; the willingness to recommend that friends and family receive the mpox vaccine; and the belief that the mpox vaccine should be distributed fairly and equitably were factors that promoted vaccination. The belief that mpox worsens tumor prognosis was a driving factor for vaccine hesitancy. This study investigated the knowledge of cancer patients about mpox and the vaccine, evaluated the acceptance and hesitancy rates of the mpox vaccine and examined the predictors of vaccination intention. We suggest that the government scientifically promote the vaccine and develop policies such as free vaccination and personalized vaccination to increase the awareness and acceptance rate of the mpox vaccine.

Change in intention and hesitancy regarding COVID-19 vaccines in a cohort of adults in Quebec during the pandemic

Although COVID-19 vaccine uptake was high in Quebec for the primary series, vaccine acceptance decreased for the subsequent booster doses. This article presents the evolution of vaccine intention, self-reported vaccination behaviors, and vaccine hesitancy over 2 years. A series of cross-sectional surveys were conducted in Quebec between March 2020 and March 2023, with a representative sample of 3,330 adults recruited biweekly via a Web panel. Panelists could have answered multiple times over the course of the project. A cohort of respondents was created to assess how attitudes and behaviors about COVID-19 vaccines evolved. Descriptive statistics and multivariate logistic regressions were performed. Among the 1,914 individuals with no or low intention of getting vaccinated in Fall 2021 (Period 1), 1,476 (77%) reported having received at least two doses in the Winter 2023 (Period 2). Not believing in conspiracy theory (OR = 2.08, 95% CI: 1.65-2.64), being worried about catching COVID-19 (OR = 2.12, 95% CI: 1.65-2.73) and not living in a rural area (ORs of other areas are 2.27, 95% CI: 1.58-3.28; 1.66, 95% CI: 1.23-2.26; 1.82 95% CI: 1.23-2.73) were the three main factors associated with being vaccinated at Period 2. Among the 11,117 individuals not hesitant at Period 1, 1,335 (12%) became hesitant at Period 2. The three main factors significantly associated with becoming vaccine hesitant were the adherence to conspiracy theories (OR = 2.28, 95% CI: 1.95-2.66), being a female (OR = 1.67, 95% CI: 1.48-1.90) and being younger than 65 years old (the ORs for 18-34, 35-49, and 50-64 compared with 65 and over are 2.82, 95% CI: 2.32-3.44; 2.39, 95% CI: 2.00-2.86 and 1.82, 95% CI: 1.55-2.15 respectively). As the pandemic is over, monitoring the evolution of vaccine attitudes and uptake will be important.

Misinformation and COVID-19 vaccine uptake hesitancy among frontline workers in Tanzania: Do demographic variables matter?

Although COVID-19 vaccination has been widely considered as an important remedy to confront COVID-19, people remain hesitant to take it. The objective of this study was to assess the moderation effects of demographic characteristics on the relationship between forms of misinformation and COVID-19 vaccine uptake hesitancy among frontline workers in Dar es Salaam and Dodoma, Tanzania. Using a sample of 200 respondents, it assessed the differences in ratings on misinformation regarding COVID-19 vaccine based on respondents' demographics. The study used a Five-point Likert scale questionnaire distributed through snowball sampling to frontline workers from Dar es Salaam and Dodoma regions. Data was analyzed using binary logistic regression. It was found that the forms of misinformation revealed were manipulated imposters, satire, fabricated contents and false contents with their connection, which they influenced COVID-19 hesitancy significantly. With exception of age, that significantly moderated hesitancy, this study uncovers that, sex and education level moderated insignificantly in predicting those who are misinformed; misinformed individuals are not any less educated or not based on one's sex, different than individuals who are informed. The study informs policy makers on devising appropriate strategies to promote COVID-19 vaccination uptake among the different contextual demographic variables. Promotion of information, media and health literacy to the general public should be considered to deter spreading of vaccine-related misinformation.

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.

Developing and validating a culturally tailored questionnaire to assess COVID-19 vaccine hesitancy in Israel's ultraorthodox Jewish population

Addressing vaccine hesitancy requires culturally adaptable tools. This study aimed to provide a better understanding of COVID-19 vaccine hesitancy in Israel's ultraorthodox Jewish community, where vaccine hesitancy is prevalent. We developed and validated a COVID-19 vaccine hesitancy questionnaire and explored correlates of intention to receive the fourth dose of the COVID-19 vaccine in this population. A mixed-methods study employing an exploratory sequential design was conducted in May-September 2022. Building on qualitative data, a questionnaire was developed and validated in a cross-sectional study when the fourth dose was recommended to all adults. Thematic analysis identified several factors influencing COVID-19 vaccine decision-making, predominantly religious authority alongside health information sources, perceived vaccine safety, effectiveness, and trust in state authorities. In the cross-sectional study, 96/106 (90.6%) participants were vaccinated against COVID-19; 5.2%, 25.0%, 65.6%, and 4.2% received 1, 2, 3, and 4 doses, respectively. Intention to receive the fourth dose (yes/maybe) was reported by 46%. A factor analysis yielded several scales expressing perceptions regarding COVID-19, with Cronbach's Alpha mostly between 0.689 and 0.887. Correlates of intention to receive the fourth dose were age ≥ 50 years: OR = 12.45 (95% CI 1.42-108.93), male-sex: 4.97 (1.47-16.81), perceiving the vaccine as important/effective and safe: 4.11 (1.29-13.13), utilizing ultraorthodox communication channels: 5.86 (1.58-21.73), and the number of previously received doses: 3.14 (1.31-7.53). Complementary evidence emphasized the role of religious authority and information sources (ultraorthodox communication channels) and balancing perceived vaccine safety and effectiveness and disease risk in COVID-19 vaccine hesitancy in Israel's ultraorthodox Jewish population.

"Going vaccine hunting": Multilevel influences on COVID-19 vaccination among racialized sexual and gender minority adults-a qualitative study

High levels of COVID-19 vaccine hesitancy have been reported among Black and Latinx populations, with lower vaccination coverage among racialized versus White sexual and gender minorities. We examined multilevel contexts that influence COVID-19 vaccine uptake, barriers to vaccination, and vaccine hesitancy among predominantly racialized sexual and gender minority individuals. Semi-structured online interviews explored perspectives and experiences around COVID-19 vaccination. Interviews were recorded, transcribed, uploaded into ATLAS.ti, and reviewed using thematic analysis. Among 40 participants (mean age, 29.0 years [SD, 9.6]), all identified as sexual and/or gender minority, 82.5% of whom were racialized. COVID-19 vaccination experiences were dominated by structural barriers: systemic racism, transphobia and homophobia in healthcare and government/public health institutions; limited availability of vaccination/appointments in vulnerable neighborhoods; absence of culturally-tailored and multi-language information; lack of digital/internet access; and prohibitive indirect costs of vaccination. Vaccine hesitancy reflected in uncertainties about a novel vaccine amid conflicting information and institutional mistrust was integrally linked to structural factors. Findings suggest that the uncritical application of "vaccine hesitancy" to unilaterally explain undervaccination among marginalized populations risks conflating structural and institutional barriers with individual-level psychological factors, in effect placing the onus on those most disenfranchised to overcome societal and institutional processes of marginalization. Rather, disaggregating structural determinants of vaccination availability, access, and institutional stigma and mistrust from individual attitudes and decision-making that reflect vaccine hesitancy, may support 1) evidence-informed interventions to mitigate structural barriers in access to vaccination, and 2) culturally-informed approaches to address decisional ambivalence in the context of structural homophobia, transphobia, and racism.

Acceptance of COVID-19 vaccine and its related determinants in Nigeria: An online survey

BACKGROUND

Vaccine hesitancy is a major challenge in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Identifying the sociodemographic factors associated with vaccine acceptance among Nigerians is crucial for improving vaccine uptake.

AIM

To assess the acceptance rate of COVID-19 vaccine and its related determinants among Nigerians.

METHODS

An online cross-sectional survey (observational study) was conducted between February 2021 and May 2021, using a questionnaire hosted on SurveyMonkey. The invitation to take part in the poll was sent out to participants through social networking platforms. A logistic regression was used to determine which sociodemographic factors were associated with vaccine acceptance constructs.

RESULTS

A total of 1800 persons responded to the survey, a larger proportion of whom were males (53.9%) and within the age group of 21-30 years (29.4%) and earned an average income of less than $500 per month (43.3%). Only 0.56% of participants had a high perceived risk of COVID-19 infection, while only 1.11% had a perceived risk of dying from COVID-19. The perception rate of the COVID-19 vaccine among participants was 51.1%, while the acceptance rate was 63.9%. There was no significant association between the COVID-19 vaccine acceptance rate and related determinants assessed, particularly age (χ² = 3.049, P = 0.550), sex (χ² = 0.102, P = 0.749), average income (χ² = 3.802, P = 0.875), and religion (χ² = 2.819, P = 0.420). Participants with chronic conditions demonstrated a higher acceptance rate compared to the general population.

CONCLUSION

Despite the positive perception observed and substantial vaccine acceptance rate among the study participants, more public health interventions are still needed to enhance vaccine acceptability in Nigeria.

Vaccine Intention, Uptake, and Hesitancy Among US Certified Food Producers: The National COVID-19 Organic Farmer Study

OBJECTIVE

To estimate COVID-19 vaccine intention, uptake, and hesitancy among essential workers.

METHODS

A cross-sectional survey of USDA-certified organic producers. An electronic survey was used for data collection. Analyses included descriptive statistics, χ2 tests, and ordinal logistic regressions.

RESULTS

The dataset consisted of 273 records. While 63% of respondents had received at least 1 dose of COVID-19 vaccine, only 17% had the recommended minimum of 2 doses. More than two-thirds of unvaccinated individuals indicated no plan to receive the vaccine, and limited perception of vaccine necessity. They indicated concerns about side effects and a distrust of the vaccines and the government. Age, education level, acreage, region, and health insurance status were variables significantly associated with the number of doses of vaccine received.

CONCLUSIONS

Interventions to encourage vaccination may target farmers who are less educated, live alone or just with one other person, lack health insurance, and run larger farms. Results also suggest focusing on enhancing trust in science and the government. Theory-based approaches that address low perception of risk and severity may be more likely to be effective with this population. Information on how US organic producers handled the COVID-19 pandemic is critical for emergency preparedness and food system stability.

A Cetylpyridinium Chloride Oral Rinse Reduces Salivary Viral Load in Randomized Controlled Trials

INTRODUCTION

Evaluating the antiviral potential of commercially available mouthrinses on SARS-CoV-2 holds potential for reducing transmission, particularly as novel variants emerge. Because SARS-CoV-2 is transmitted primarily through salivary and respiratory secretions and aerosols, strategies to reduce salivary viral burden in an antigen-agnostic manner are attractive for mitigating spread in dental, otolaryngology, and orofacial surgery clinics where patients may need to unmask.

METHODS

Patients (n = 128) with confirmed COVID-19-positive status within 10 days of symptom onset or positive test result were enrolled in a double-blind randomized controlled trial of Food and Drug Administration-approved mouthrinses containing active ingredients ethanol, hydrogen peroxide, povidone iodine, chlorhexidine gluconate, cetylpyridinium chloride (CPC), or saline. The CPC, ethanol, and sterile water rinses were followed in a second double-blind randomized controlled trial (n = 230). Participants provided a saliva sample before rinsing (baseline) and again at 30 and 60 min after rinse. Quantitative polymerase chain reaction was used to determine salivary SARS-CoV-2 viral load at all time points. An adjusted linear mixed-effect model was employed to compare viral load after rinsing relative to baseline.

RESULTS

The rinse containing CPC significantly reduced salivary SARS-CoV-2 viral load 30 min postrinse relative to baseline (P = .015), whereas no other rinse significantly affected viral load at 30 min after rinsing. At 60 min postrinsing, no group had a significant reduction in SARS-CoV-2 copy number relative to baseline, indicating a rebound in salivary viral load over a 1-hour window. Participants indicated a fair to good rinsing experience with the CPC product and high willingness to use oral rinses before and during dental and medical health care visits.

CONCLUSIONS

Our findings suggest that preprocedural oral rinsing could be implemented as a feasible, inexpensive approach to mitigate spread of SARS-CoV-2 and potentially other enveloped viruses for short periods, which is relevant to clinical procedures involving the nasal and oropharyngeal region.

KNOWLEDGE TRANSFER STATEMENT

Rinsing with a cetylpyridinium chloride-containing mouthrinse can significantly reduce salivary SARS-CoV-2 viral load for up to 30 min; patients are willing to use mouthrinses in medical and dental settings to limit transmission risk in clinics.

Immediate adverse events following immunization (AEFI) in drive-through COVID-19 vaccination campaign in Yogyakarta, Indonesia: A cross-sectional study

Background & objectives The COVID-19 pandemic has led to unprecedented global immunization efforts, with drive-through vaccination campaigns established to expedite and ensure safe coverage. However, research on immediate adverse events following immunization (AEFI) in these settings is limited. This study aims to evaluate the frequency and characteristics of immediate AEFI during drive-through COVID-19 vaccination campaigns in Yogyakarta, Indonesia, using the Sinovac/CoronaVac vaccine Methods This cross-sectional study utilized secondary data from the local vaccine registry managed by the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia, from July 27 to September 6, 2021. Participants included individuals aged over 11 yr without underlying medical conditions such as diabetes, hypertension, cancer, or asthma. Key characteristics recorded were age, gender, and AEFI. Results Out of 27,459 registrants, only 20,817 were eligible and received a dose. The median participant age was 20 yr (IQR 10); 47 per cent were male (9,712) and 53 per cent female (11,105). The highest vaccination day was September 6, 2021, with 3,883 doses (18%). Among the 79 participants who experienced AEFI [0.38%; 95% Confidence Interval (CI): 0.30-0.47], the median age was 19 yr (IQR 8); 41 per cent were male (34) and 59 per cent female (48). Systemic adverse events (92%) were more common than local events (6.3%), with dizziness (77.2%) being most prevalent. Interpretation & conclusions The findings of this study suggest that immediate AEFI occurred rarely in the drive-through vaccination setting, indicating that this method appears safe and efficient for COVID-19 vaccinations, particularly in the context of immediate AEFI. Most adverse events were mild, underscoring the importance of preparedness and close monitoring in drive-through vaccination campaign sites to ensure patient safety and enhance vaccine confidence.

Emerging global patterns of COVID-19 vaccine information fatigue in 23 countries in 2023

Vaccine information fatigue, exacerbated by the infodemic, misinformation, and cultural influences, hampers public responsiveness to the uptake of vaccines for COVID-19 and other vaccine-preventable diseases. This cross-sectional study of 23,000 respondents surveyed in 23 countries in October 2023 analyzed trust in information sources, perceptions of the pandemic's conclusion, and confidence in one's ability to discern false information from true and the association of these factors with willingness to pay attention to COVID-19 vaccine information, adjusting for sociodemographic characteristics. Results revealed that satisfaction with health authority communication was positively associated with individuals' willingness to pay attention to COVID-19 vaccine information in all 23 countries. Confidence in one's own capacity to distinguish true information from false was associated with willingness in 20 countries. Belief that the pandemic is over was associated with unwillingness to pay attention to COVID-19 vaccine information in 14 countries. These findings underscore the need for tailored communication strategies that build trust in information sources, combat complacency, and enhance discernment skills to address vaccine and pandemic fatigue, aiming to sustain public engagement with vaccine information and, ultimately, support vaccination efforts.

Communicating COVID-19 vaccine information to Chinese communities in the UK: a qualitative study of their knowledge, information sources and trust

Introduction

In late 2020, the COVID-19 vaccine acceptance rates of Chinese people living in the UK were estimated between 52% and 57%, significantly lower than that of the general population (76%). This disparity formed a primary motivation for this study which explored Chinese communities' overall understanding of and attitude towards the COVID-19 vaccines, the sources of information about the vaccines and levels of (dis)trust in these sources.

Methods

29 focus groups with 154 participants from UK-based Chinese communities of varied sociodemographic backgrounds were conducted between March and November 2021. Focus group data were coded with NVivo and analysed using thematic analysis.

Results

Participants generally had a good understanding of the health benefits of the vaccines, however, many still had concerns about vaccine safety and efficacy. They accessed COVID-19 vaccine information from a multitude of sources and had diverse information needs which to a large extent shaped their knowledge of and attitude towards the vaccines. Participants generally had good digital access and some have developed good digital literacy enabling discernment of mis/disinformation. The ways in which they accessed and engaged with various types of information sources were differentiated by diversities in country/regions of origin, years of residence and main language/dialects spoken. They also demonstrated varying degrees of trust about the communication around vaccines depending on the perceived expertise of the authority, their character and the perceived accuracy and transparency of the information.

Conclusion

The UK government and health authorities need to understand Chinese communities' diverse information needs and cultural practices to form culturally and linguistically appropriate COVID-19 vaccine communication strategies to develop trust, targeting not the entire community but subgroups within the community via credible media sources and community networks.

Sex differences in COVID-19 vaccine confidence in people living with HIV in Canada

Background

Understanding the roots of vaccine confidence in vulnerable populations, such as persons living with HIV (PLWH), is important to facilitate vaccine uptake, thus mitigating infection and spread of vaccine-preventable infectious diseases. In an online survey of PLWH conducted in Canada during winter 2022 (AIDS and Behav 2023), we reported that the overall COVID-19 vaccination uptake rate in PLWH was similar by sex. Here, we examined attitudes and beliefs towards vaccination against COVID-19 based on sex.

Methods

Between February and May 2022, PLWH across Canada were recruited via social media and community-based organizations to complete an online survey consisting of a modified Vaccine Hesitancy Scale (VHS) questionnaire with items from the National Advisory Committee on Immunization Acceptability Matrix. Descriptive statistics were used to summarize participant characteristics and responses to the VHS questionnaire by sex. The effect of biological sex on total VHS score, two subscales ("lack of confidence" and "perceived risk") was assessed separately by linear regression adjusting for other key baseline variables.

Results

Of 259 PLWH, 69 (27 %) were females and 189 (73 %) were males. Sixty-six (26 %) of participants self-identified as a woman, 163(63 %) as a man and 28(11 %) as trans/two-spirited/queer/non-binary/agender/other. The mean age (SD) was 47 ± 14 years. Females were less likely to believe that COVID-19 vaccination was: important for his/her own health (71 % vs. 86 %); a good way to protect themselves from infection (68 % vs. 86 %); that getting the COVID-19 vaccine was important for the health of others in his/her community (78 % vs. 91 %); believed recommendations by their doctor/health care provider about COVID-19 vaccines (78 % vs. 88 %); that information about COVID-19 vaccines from public health officials was reliable and trustworthy (56 % vs. 75 % vs); COVID-19 vaccines are effective in preventing COVID-19 infections (61 % vs. 82 %) and that all COVID-19 vaccines offered by government programs in their communities were important for good health (70 % vs. 87 %). Although more males than females felt that new vaccines generally carry more risks than older vaccines (19 % vs 16 %,), fewer males than females endorsed concern about serious side effects of COVID-19 vaccines (33 % vs 45 %).The linear regression model showed females had a significantly higher VHS total score than males (adjusted mean difference 0.38; 95 % confidence interval (CI) 0.13-0.64; p = 0.004), indicating greater COVID-19 vaccine hesitancy among females. It was observed that females had a greater "lack of confidence in vaccines" score than males (adjusted mean difference 0.43; 95 % CI 0.14-0.73; p = 0.004). We did not observe a significant difference in "perceived risk in vaccines" between males and females (adjusted mean difference 0.20; 95 % CI -0.07-0.46; p = 0.1). The inadequate number of participants self-identifying as different from biological sex at birth prevented us from analyzing the VHS score based on gender identity.

Conclusions

Among PLWH, females showed greater COVID-19 vaccine hesitancy than males. Specifically, compared with males, females had a higher level of lack of confidence in vaccines. Fewer females than males believed that COVID-19 vaccines had health benefits at both the personal and societal levels and that recommendations made by their doctor/health care provider and public health officials are reliable and trustworthy. Further investigation into reasons for this difference in opinion still needs to be elucidated. Educational interventions targeted toward females living with HIV are especially needed to increase confidence in vaccination.

Trust in the science behind COVID-19 vaccines as a driver of vaccine acceptance in the United States, 2021-2023

Objectives

To evaluate changes in public trust in the science behind COVID-19 vaccines in the United States (US) from 2021 to 2023, and to assess how loss of a family member or close friend to COVID-19, influences this trust and vaccine acceptance.

Methods

Using stratified random sampling for key demographic variables, including age, gender, race/ethnicity, region, and education level, the study analyzes data from a series of cross-sectional surveys conducted in 2021, 2022 and 2023. Descriptive statistics were employed to summarize the socio-demographic characteristics of the respondents and their levels of trust in science and vaccine acceptance. Weighted logistic regression models were applied to assess the relationships between trust in science, vaccine acceptance, and socio-demographic factors. These models controlled for potential confounding variables and allowed for the estimation of adjusted odds ratios (aOR) and 95% confidence intervals (CI), highlighting the key predictors of vaccine acceptance and willingness to receive future recommended boosters.

Results

The results indicate that trust in science remained relatively stable over the study period and continued to be a strong predictor of vaccine acceptance, which was higher among male respondents, those with university degrees, and those with higher than median income. Notably, the experience of personal loss was significantly related to an individual's trust in science and vaccine acceptance.

Conclusions

Trust in the science behind COVID-19 vaccines appears to have been a crucial factor in US vaccine acceptance, with respondents who expressed higher trust being significantly more likely to accept the vaccine and express willingness to take future boosters. To maintain and enhance public trust in vaccination programs, trust in health communication from public sources, particularly the CDC, must be strengthened, as trust in the CDC was also found to be significantly correlated with both vaccine acceptance and future booster uptake. Personal experiences of loss due to COVID-19 were important predictors of trust in science and vaccine acceptance, highlighting the need for public health communications to be sensitive to the emotional impact of loss and grief along with the diverse socio-economic and educational backgrounds of the US population.

COVID-19 vaccine hesitancy in a small rural southern state: Results of a weighted random sample survey

Objective

COVID-19 remains a significant health threat to the United States (U.S.) and the world even after the development of effective vaccines. Throughout the pandemic, rural areas have been more hesitant to be vaccinated for COVID-19 than more urban counterparts. The purpose of this study was to assess predictors of vaccine hesitancy in a small, largely rural, southern state using a multivariate model that would allow an assessment of independent predictors of COVID-19 vaccine hesitancy.

Methods

Cross-sectional survey research was conducted using data collected from a weighted random sample of 1500 individuals residing in Arkansas, U.S. Data were collected using random digit dialing of landline and cell phone numbers between July 12 and July 30, 2021. Participants were asked about their hesitancy to be vaccinated for COVID-19. Data were analyzed using bivariate odds ratios and cumulative logit model.

Results

Results found 47 % of the sample were hesitant to be vaccinated. Bivariate analysis found vaccine hesitancy to be related to age, race/ethnicity, rural residence, education, employment, and having had COVID-19. Multivariate analysis showed sex, age, rural residence, and history of having had COVID-19 were associated with hesitancy. A history of vaccination/trust in vaccines remained strongly negatively associated with hesitancy.

Conclusion

Findings suggest population diversity may account for vaccine hesitancy across jurisdictions, suggesting public health messages be tailored to a local audience. The strongest finding suggests vaccinations should be emphasized in general to build habits of being vaccinated.

How Attribution of COVID-19 Crisis Responsibility Predicts Hong Kong Citizens' Intention to Accept Vaccination

BACKGROUND

This study aims to illuminate the role of perceived crisis responsibility in shaping vaccination intention. By using the case of Hong Kong during the COVID-19 pandemic, we examined whether and how the allocation of crisis responsibility to the government predicts the public's intention to take vaccines, particularly by investigating its underlying mechanism.

METHOD AND RESULTS

Based on a population-representative sample of Hong Kong adults (N = 3188), our results indicated that (1) the attribution of crisis responsibility directly led to lower vaccination intention, and (2) it also had indirect influences on vaccination intention through trust and anger; specifically, the crisis attribution resulted in less willingness to take vaccines via a decreased trust in government health agencies. We also found a serial mediation pathway in which anger aroused by the crisis attribution could decrease trust, which, in turn, yielded lower vaccination intentions.

CONCLUSION

The findings of this study offer theoretical insights into the role of attribution of crisis responsibility in affecting vaccination decisions during a public health emergency. Further, these findings provide directions for crisis managers and public health authorities to develop communication strategies to motivate vaccine uptake and formulate an approach to tackle the pandemic crisis.

A global survey to understand general vaccine trust, COVID-19 and influenza vaccine confidence

Introduction

The COVID-19 pandemic has greatly impacted the way that the world views vaccines. While safe and effective, COVID-19 vaccines were, and continue to be met with hesitancy and misinformation. We aimed to understand public perceptions and trust in COVID-19 vaccinations and how the pandemic has impacted perceptions of non-COVID-19 vaccines.

Methods

Survey data were collected between August 7, 2023-August 16, 2023, from 7,000 respondents aged 18 years and older from the United States (n = 1,000); Nigeria (n = 1,000); United Kingdom (n = 1,000); France (n = 1,000); Canada (n = 1,000); Brazil (n = 1,000); and India (n = 1,000).

Results

Trust in COVID-19 vaccines was highest in Brazil (84.6%) and India (80.4%) and lowest in the United States (63.5%) and France (55.0%). 47.5% of respondents agreed that they trust traditional protein-based vaccines more than mRNA vaccines, 13.5% disagree and 39.0% are neutral about their trust in protein-based versus mRNA vaccines. Overall, 53.9% of respondents reported that the COVID-19 pandemic impacted their perceptions of vaccines with half of these respondents (51.7%) reporting that the pandemic made them think that other vaccines are more important as they understand how critical vaccines can be at preventing serious illnesses.

Discussion

These data can be used by health system decision makers, public health and researchers to understand how vaccine trust impacts perceptions of COVID-19 and influenza vaccines globally and develop tailored interventions that address local concerns.

COVID-19 vaccine hesitancy, trust, and communication in Sarlahi District, Nepal

BACKGROUND

Strategies to increase COVID-19 vaccine coverage require an understanding of the extent and drivers of vaccine hesitancy and trust in government related to COVID-19 vaccine programs, especially in low-resource communities.

METHODS

We conducted a cross-sectional household survey post-COVID-19 vaccine introduction among adults (n = 362) in four municipalities in Sarlahi District, Nepal from August to December 2022. The survey included modules on participant demographics and socioeconomic factors and vaccine hesitancy, information seeking, and trust in authorities related to COVID-19 vaccination.

RESULTS

Of the study participants, 38.4 % expressed hesitancy related to COVID-19 vaccination. The adjusted odds of being "vaccine hesitant" were significantly lower among the older adults (51+ years) relative to younger (<30 years) (aOR: 0.49, CI: 0.24-0.97) and among males relative to females (aOR: 0.51, CI: 0.26, 0.95). The study population highly trusted the government's handling of the COVID-19 pandemic. While for most, self-reported access to vaccination opportunities was high (88.4 %), 70.4 % of participants did not know if vaccines were in stock at their local vaccination facility. Commonly reported statements of misinformation include the vaccine being developed in a rush or too fast (21.5 %), COVID-19 infection can be effectively treated with ayurvedic medicine(16.3 %) and obtaining immunity from natural infection is better than through vaccination (19.9 %). The primary sources of information on COVID-19 programs were family and friends (98.6 %), healthcare professionals (67.7 %), Female Community Health Volunteers (FCHVs) (61.9 %), television (56.4 %), and radio (43.1 %).

CONCLUSION

Although many respondents expressed concerns about COVID-19 effectiveness and safety, a high proportion trusted COVID-19 information provided by healthcare workers and approved of the government's response to the pandemic. This study highlights an opportunity to design new evidence-based communication strategies to improve vaccine confidence delivered through frontline government healthcare workers. Approaches could be targeted to certain communities in the region shown to have higher vaccine hesitancy, including younger people and women.

Understanding structural inequities in Covid-19 vaccine access and uptake among disability, transgender and gender-diverse communities in India

INTRODUCTION

Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India.

METHODS

Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach.

RESULTS

Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions.

CONCLUSION

This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.

From infodemic to resilience: Exploring COVID-19 protective measures in armed-conflict zone

The proliferation of inaccurate and misleading information about COVID-19 on social media poses a significant public health concern. This study examines the impact of the infodemic and beneficial information on COVID-19 protective behaviors in an armed-conflict country. Using the protective action decision model (PADM), data were collected from 1439 participants through a questionnaire in Yemen between August 2020 and April 2021. Structural equation modeling tested hypotheses generated by the PADM. The findings indicate that the infodemic reduces the likelihood of individuals adopting protective measures against COVID-19. Surprisingly, official announcements by accountable authorities do not moderate the relationship between the infodemic and protective responses. These results highlight the need for further research on resilience in armed-conflict countries. This study contributes to understanding armed-conflict countries' unique challenges in combating health crises. Addressing the infodemic and promoting accurate information is crucial in enhancing protective behaviors and mitigating the negative impact of misinformation. Policymakers and public health authorities can utilize these insights to develop targeted interventions and communication strategies that ensure accurate information dissemination and encourage the adoption of adequate protective measures.

Acceptance-Hesitancy of COVID-19 Vaccination and Factors Affecting It in Adults: Systematic Review Study

BACKGROUND

Despite the advent of vaccines against COVID-19, there is considerable variation in the acceptance and hesitancy towards the vaccination program across different countries. The objective of this study was to ascertain the prevalence of hesitancy and acceptance regarding the use of the vaccine against the novel coronavirus, also known as COVID-19, and to identify the factors that influence these attitudes.

MATERIALS AND METHODS

All the cross-sectional studies were retrieved from the PubMed databases, the Web of Science ISI, Scopus, and the Cochrane Library. Papers published in English between 2 November 2019 and 23 May 2023 were subjected to further assessment based on their title, abstract, and main text, with a view to ensuring their relevance to the present study.

RESULTS

Following an exhaustive investigation, 59 studies were selected for screening in this systematic review. The most frequently employed method of data collection was the online survey. The study sample comprised 59.12% women and 40.88% men, with ages ranging from 16 to 78 years. The proportion of individuals accepting the vaccine ranged from 13% to 96%, while the proportion of those exhibiting hesitancy ranged from 0% to 57.5%. The primary reasons for accepting the COIVD-19 vaccine were a heightened perception of risk associated with the virus and a general trust in the healthcare system. The most frequently cited reasons for vaccine hesitancy in the context of the ongoing pandemic include concerns about the potential dangers of the vaccines, the rapid pace of their development, the possibility of adverse effects (such as infertility or death), and the assumption that they have been designed to inject microchips.

DISCUSSION

A variety of socio-demographic factors are implicated in determining the rate of vaccine acceptance. A number of socio-demographic factors have been identified as influencing vaccine acceptance. These include high income, male gender, older age, marriage, the presence of older children who have been vaccinated and do not have chronic diseases, high education, and health insurance coverage.

CONCLUSION

Eliminating vaccine hesitancy or increasing vaccine acceptance is a crucial factor that should be addressed through various means and in collaboration with regulatory and healthcare organizations.

The effect of public tolerance towards corruptive behaviour on healthcare efficiency and equity - The case of the UK's COVID-19 vaccination programme

Over the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption on a global scale. In response, governments have been under pressure to ensure equitable vaccine access while meeting vaccination targets quickly. These challenging circumstances created opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It integrates primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scotland. Employing a survival analysis approach, we estimate Cox Proportional Hazards Models to examine the time required to reach vaccination targets. Our findings suggest moderate tolerance towards corruptive behaviour among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Notably, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the local rollout of the vaccination programme, it appeared to have accelerated its rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this increase in efficiency seems to have come at the cost of reduced equity in vaccine distribution. These findings suggest a trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for balanced health policies that ensure fair and effective distribution of vaccines in the future.

Temporal trends in online searches related to COVID-19 vaccine safety: A digital infodemiology study

Background

The rapid development of COVID-19 vaccines may have raised public concerns about their safety and side effects in the United States (US). This study aimed to assess trends in online searches related to the safety and side effects of COVID-19 vaccines in the US from 2021-2022.

Methods

Google COVID-19 Vaccination Search Insights was used to analyze searches about COVID-19 vaccine safety and side effects in the US from January 4, 2021, to November 21, 2022 (98 weeks). Data were scaled from 0 (low interest) to 100 (high interest) as a fixed scaling factor called scaled normalized interest (SNI) to indicate relative search interest over time and by location. A joinpoint regression analysis was used to determine the search trends during the study period.

Results

Analysis included 709 counties across 38 US states. Searches of COVID-19 vaccine safety and side effects peaked in April 2021 in the District of Columbia (SNI: 35.8), Massachusetts (29.7), New Hampshire (27.4), Connecticut (27.3), and Maine (26.7), then decreased significantly by an average monthly percentage change (AMPC) of -16.6% (95% CI -19.9 to -13.3) until July 2022. Overall AMPC from January 2021 to November 2022 was -8.9% (95% CI -16.2 to -0.9; P<0.001).

Conclusion

Online searches related to COVID-19 vaccine safety and side effects decreased dramatically over time, supporting the utility of digital surveillance to track real-time vaccine safety concerns. This study provides insights into public interest in COVID-19 vaccine risks and can help monitor potential safety issues.

The acceptance of COVID-19 vaccines in Rwanda: a cross-sectional study

The first reported case of Coronavirus Disease 2019 (COVID-19) in Rwanda occurred on March 14 2020. By the end of July 2024, a total of 133,518 individuals had tested positive for the infection, resulting in 1,468 deaths and 132,039 had fully recovered. The success of COVID-19 elimination in Rwanda hinges on the public's level of acceptance of the COVID-19 vaccination. Although COVID-19 is no longer a pandemic anymore, the World Health Organisation recommends countries vaccinate their populations to protect them from COVID-19 and its variants. Globally, COVID-19 has affected 704,753,890 people, caused 7,010,681 deaths and 675,619,811 have recovered. This study aimed to assess the acceptability of COVID-19 vaccines among adults aged 18 years and above in Rwanda. A cross-sectional study was conducted from January to March 2022 to determine the associations between COVID-19 vaccine acceptance (VA) with respondents' characteristics, using logistic regression analysis. This study enrolled 2,126 respondents with a mean age of 31 years, the majority of whom were females (82.2%), 51.4% had completed primary education, and 78.7% were married. Most respondents recognized the importance of COVID-19 vaccination for both personal health and community well-being. The study found a high rate of COVID-19 vaccine acceptance, with 91.6% of respondents expressing VA and an overall VA rate of 98.2%. Having a relationship with the child(ren) was the only characteristic associated with COVID-19 vaccine acceptance (p; 3.2 × 10- 3, OR; 2.9, 95% C.I; 1.4-5.9). In conclusion, the study found a high rate of COVID-19 vaccine acceptance among adults in Rwanda, with COVID-19 associated with having a relationship with the child(ren). The study recommends the need for mass educational campaigns and awareness-raising efforts to understand of COVID-19 vaccines.

Knowledge, Attitudes, and Practices towards Influenza Vaccine among Guangzhou Residents: A Cross-Sectional Study

BACKGROUND

Influenza vaccination is an important prevention strategy for flu illness. However, the vaccination rate is still low in Guangzhou, China. This study aimed to understand the status of knowledge, the attitude towards the vaccines' reliability and safety, and other aspects associated with the willingness and practice of influenza vaccines in the pediatric and adult populations of Guangzhou city.

METHODS

This study was performed in eleven districts in Guangzhou between November 2020 and December 2020, including the Yuexiu, Liwan, Haizhu, Tianhe, Baiyun, Panyu, Huadu, Nansha, Huangpu, Zengcheng, and Conghua districts. The parents of children and teenagers under the age of eighteen in Guangzhou were surveyed using self-administered questionnaires in four domains: demographic information, the knowledge status and perception of influenza vaccination, the willingness and attitude towards influenza vaccination, and previous vaccine uptake. A multivariable logistic regression was employed to assess the possible determinants of willingness and practice to receive influenza vaccination, calculating the odds ratios (ORs) and 95% confidence interval (CI). A two-sided p-value < 0.05 was deemed statistically significant.

RESULTS

A total of 13,213 valid questionnaires were collected (validity rate 98.8%). Out of these participants, 42.62% (5631 participants) expressed a willingness to receive the influenza vaccine, while 55.40% (7320 participants) reported that their children and teenagers had been vaccinated against the flu. Furthermore, 40.44% of the respondents (5343 participants) or other family members had received the influenza vaccine. Logistic regression indicated that factors such as being female (OR = 1.395, 95% CI: 1.278-1.522), being involved in the work of COVID-19 prevention and control (1.551, 1.396-1.724), affirming the preventive effects of vaccination (2.474, 2.106-2.906), knowing about annual influenza vaccination (2.756, 2.540-2.992), and understanding prioritized influenza vaccination populations (1.464, 1.343-1.596) were all positively associated with vaccination willingness. Conversely, middle-aged persons (aged 40-49 years old) (0.726, 0.617-0.853), higher educational levels (undergraduate versus middle school) (0.858, 0.768-0.959), heightened concerns about vaccine safety (considering side effects are obvious versus considering it is safe and basically no side effects) (0.284, 0.188-0.429) and lower knowledge scores (0.813, 0.701-0.942) were adversely linked with vaccination willingness.

CONCLUSION

These findings provide essential insights for altering the perception of influence and influenza vaccination, as well as enhancing health communication strategies to improve influenza vaccine uptake among Guangzhou residents.

Reconsidering inequalities in COVID-19 vaccine uptake in Germany: a spatiotemporal analysis combining individual educational level and area-level socioeconomic deprivation

Combining the frameworks of fundamental causes theory and diffusion of innovation, scholars had anticipated a delayed COVID-19 vaccination uptake for people in lower socioeconomic position depending on the socioeconomic context. We qualify these propositions and analyze educational differences in COVID-19 vaccination status over the first ten months of Germany's vaccination campaign in 2021. Data from the study "Corona Monitoring Nationwide" (RKI-SOEP-2), collected between November 2021 and February 2022, is linked with district-level data of the German Index of Socioeconomic Deprivation (GISD). We estimated the proportion of people with at least one vaccination dose stratified by educational groups and within different settings of regional socioeconomic deprivation at three time points. Logistic multilevel regression models were applied to adjust for multiple covariates and to test cross-level-interactions between educational levels and levels of area-level socioeconomic deprivation. Vaccination rates were lower among respondents with lower education. With increasing area-level socioeconomic deprivation, educational differences were larger due to particularly low vaccination rates in groups with low education levels. The analysis of vaccination timing reveals that educational gaps and gaps by area-level socioeconomic deprivation had appeared early in the vaccination campaign and did not close completely before the 4th wave of COVID-19 infections.

Hesitation towards COVID-19 booster vaccination among dialysis patients: a cross-sectional study in Taizhou, China

PURPOSE

This research aimed to explore hesitation towards the COVID-19 booster vaccine among dialysis patients and study the association between COVID-19 pandemic-induced health behavior and vaccination hesitancy.

METHODS

A self-administered online questionnaire evaluating dialysis patients' hesitation to take COVID-19 booster vaccination was conducted between March 24 and 22 April 2022 in Taizhou, China. The logistic regression method was applied to identify factors associated with vaccination hesitancy, and all data were analyzed using R software.

RESULTS

Of the 365 study participants, 272 (74.5%) individuals hesitated to take the booster dose. Health behavior was found to be a significant factor for hesitation to take COVID-19 vaccines, with OR (95% CI) of 1.09 (1.02-1.17). Influenza vaccination history was also significantly associated with the hesitation (OR (95% CI) = 0.39 (0.21-0.74)). In addition, participants with higher education levels exhibited lower vaccine hesitancy compared to those with junior secondary or below, with ORs (95% CIs) of 0.49 (0.27-0.91) for senior secondary and 0.35 (0.14-0.89) for junior college or above, respectively.

CONCLUSION

The proportion of hesitancy for taking the booster vaccination of the COVID-19 vaccine was high among dialysis patients. Health behaviors, influenza vaccination history, and education levels were risk factors in their vaccination hesitancy. These findings may aid efforts to help vaccinate people with underlying diseases against future pandemics.