Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country

Determining factors for COVID-19 vaccine hesitancy among Brazilians: a study using structural equation modeling

OBJECTIVES

to investigate the factors influencing vaccine hesitancy against COVID-19 among Brazilians.

METHODS

this research employed an observational and analytical approach, utilizing a web-based survey. Data collection took place in 2020, and data analysis was conducted using structural equation modeling.

RESULTS

the prevalence of vaccine hesitancy was found to be 27.5% (1182 individuals). There is a negative correlation between belief in conspiracy theories and social influence. Among the various beliefs associated with vaccination intentions, only conspiracy beliefs exhibited significant predictive value. Thus, the findings suggest that personal beliefs significantly impact hesitancy towards vaccination, and also indicate that trust in governmental bodies is inversely related to hesitancy.

CONCLUSIONS

vaccine hesitancy emerges as a multifaceted phenomenon influenced by a complex array of factors, including personal beliefs, trust in governmental bodies, and healthcare systems.

Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method

BACKGROUND

 Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey.

OBJECTIVE

 To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants.

METHODS

 Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items.

RESULTS

 The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth.

CONCLUSIONS

 Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.

Heritage and hesitancy: how preference for traditional Chinese medicine influences vaccine attitudes

Introduction

Vaccine hesitancy, amplified by the COVID-19 pandemic, is a pressing public health challenge. This study investigates the association between Traditional Chinese Medicine (TCM) preference and COVID-19 vaccine hesitancy within China.

Methods

The study uses data from the 2021 Chinese General Social Survey (CGSS) (N = 2,690). Logistic regressions and Karlson-Holm-Breen (KHB) method are employed to analyzed the relationship between TCM preference and vaccine hesitancy.

Results

The study reaffirms prior findings by revealing a robust and stable association between TCM preference and vaccine hesitancy, which remains unaffected by socioeconomic and demographic confounders, as well as institutional trust dynamics of healthcare system. Contrary to expectations, TCM enthusiasts do not exhibit vaccine hesitancy based on divergent epistemological views concerning vaccine risks and immunity acquisition compared to biomedicine.

Discussion

This research enriches understandings of the intricate relations between healthcare paradigms and vaccine attitudes, inviting further inquiry into the role of CAM in shaping vaccination behaviors across different cultures and contexts. The insights bear significant public health implications for enhancing vaccine acceptance and coverage, particularly among populations where CAM practices wield substantial influence.

COVID-19 vaccine acceptance and its associated factors in the Western Pacific Region

Background

COVID-19 vaccines effectively reduced the severity of the pandemic, but the mass rollout was challenged by vaccine hesitancy, which was related to heterogenous factors-such as religiosity, mistrust, and a lack of scientific knowledge-around the globe. Distinguishing these potential influencers and quantifying their impacts would help authorities to tailor strategies that boost vaccine confidence and acceptance.

Methods

We conducted a large-scale, data-driven analysis on vaccine acceptance and actual uptake in eight Western Pacific countries before (2021) and after (2022) the mass COVID-19 vaccine rollouts. We compared vaccine acceptance or uptake rates between different subpopulations using Bootstrap methods and further constructed a logistic model to investigate the relationship between vaccine endorsement and diverse socio-demographic or trust-related determinants at these two time points.

Findings

Substantial between-country differences in vaccine acceptance and uptake were observed across the Western Pacific, with Mongolia, Vietnam, Laos, Cambodia, and Malaysia being more pro-vaccine than the other three countries (Japan, South Korea, and the Philippines). Actual vaccination rates in 2022 were all higher than predicted from the 2021 responses. Influencers for vaccine endorsement were country-specific, but generally, groups susceptible to vaccine hesitancy included females, the less-educated, and those distrusting vaccines or health care providers.

Interpretation

Our findings demonstrate the successful translation of vaccine intent to actual uptake with the deployment of COVID-19 vaccination in the Western Pacific. Increasing vaccine confidence and supressing dissemination of misinformation may play an essential role in reducing vaccine hesitancy and ramping up immunisation.

Funding

AIR@InnoHK.

Hepatitis B and influenza vaccination coverage in healthcare workers, the elderly, and patients with diabetes in Malaysia

Adult immunization remains to be a neglected issue in developing countries including Malaysia. This nationwide study determined the vaccination coverage of hepatitis B and influenza among Malaysia's healthcare workers (HCWs), the elderly (aged 60 y and above) and patients with diabetes, who are the participants of The Malaysia Cohort Program. The participants were categorized based on their occupation, age and medical history. Self-reported questionnaire was used to assess the participant's hepatitis B and influenza vaccination status. A Chi-square test and logistic regression analyses were performed to determine the risk factors associated with vaccination behavior. The hepatitis B vaccination coverage for healthcare workers, elderly, and patients with diabetes were 34.6%, 10.1% and 9.8%, respectively. The influenza vaccination coverage rates for healthcare workers, the elderly and patients with diabetes were 26.3%, 5.5% and 6.4%, respectively. The Chinese were more likely to be vaccinated against hepatitis B, while Malay was more likely to be vaccinated against influenza. Individuals with higher education and living in urban areas were more likely vaccinated than those with low education levels and who lived in rural areas. The low vaccination coverage for healthcare workers was alarming because hepatitis B and influenza were subsidized for the healthcare workers. The hepatitis B and influenza vaccination coverage among healthcare workers, elderly and patients with diabetes in Malaysia were low. Specific interventions such as educational and awareness programs should be conducted to increase the vaccination rate among adults, especially those at high risk.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh

INTRODUCTION

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

METHODS

A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance.

RESULTS

Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy.

CONCLUSIONS

These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study

People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = -3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH.

The Impact of Social Media on Vaccination: A Narrative Review

Vaccine hesitancy poses a significant global health challenge, fueled by misinformation and anti-vaccination campaigns on social media platforms (SMPs). This study examines the influence of social media on coronavirus disease 2019 (COVID-19) and non-COVID-19 vaccination in Asia during the peri-pandemic period. Through a comprehensive analysis of available literature, we aim to elucidate the role of SMPs in shaping vaccination attitudes and behaviors. The findings highlight the detrimental impact of social media on vaccination efforts and provide insights into addressing vaccine hesitancy during this critical period. A narrative review was conducted by searching the PubMed, Scopus, and Google Scholar databases from inception to May 26, 2022. Only English-language articles involving human participants from Asian countries were included in this review. Out of the 228 articles identified through the database search, 14 articles were included in the final analysis. The prevalence of COVID-19 vaccine hesitancy or negative attitudes towards COVID-19 vaccines in Asian countries was found to be high, ranging from 20% to 55% across countries. Notably, reliance on SMPs for vaccine-related information was associated with a higher likelihood of COVID-19 vaccine hesitancy. This trend coincided with the proliferation of misinformation and conspiracy theories that portrayed COVID-19 vaccines as harmful during the pandemic. Similar patterns were observed for other types of vaccines, including polio, measles mumps and rubella, and diphtheria-tetanus-pertussis vaccines. The use of SMPs was also found to be associated with increased fear among caregivers in Asian countries, as well as a 3-4 times higher likelihood of delayed immunization. SMPs negatively impact vaccine intent in Asia due to misinformation and anti-vaccination campaigns during the pandemic. However, they can be a powerful tool for healthcare providers and policymakers to promote informed decision-making. Efforts should focus on leveraging SMPs to disseminate reliable information and combat hesitancy, fostering a well-informed and vaccinated population in Asia.

Barriers to measles mumps rubella vaccine acceptance in the three southern border provinces of Thailand

Purpose

This qualitative study utilizing phenomenological methodology aimed to depict parental measles mumps rubella (MMR) vaccine acceptance through the work experiences of health personnel.

Materials and Methods

Twenty-two public health workers working as vaccination providers in the three southern border provinces of Thailand were recruited. In-depth, face-to-face, semi-structured interviews were conducted. Data were analyzed using thematic analysis.

Results

Four main themes emerged: (1) religious beliefs, (2) personal disagreements, (3) fear and mistrust regarding potential vaccine side effects, and (4) misperceptions about the potential severity of measles. Four subthemes were identified: (1) haram (prohibited), (2) the will of Allah, (3) spousal disagreement, and (4) disagreement from a religious leader. The results of this study indicated that perceived religious prohibition was the most important reason for refusing to vaccinate among Muslim parents. Vaccine-hesitant parents were concerned that the vaccine might contain gelatin derived from pig products. Also, halal certification of the vaccine was required from Muslim parents to ensure that vaccine has been approved for Muslims. Meanwhile, a lack of knowledge and positive attitudes concerning immunizations of vaccine-hesitant parents were also found as predominant reasons for incomplete childhood immunizations in the deep south of Thailand.

Conclusion

Health education and engagement by religious leaders to endorse the vaccination and bridge the gap between religious beliefs and vaccine acceptance is needed to overcome this issue. This study findings could be effectively applied to improve vaccination uptake in a Muslim majority context.

A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.

Factors Associated with COVID-19 Vaccine Refusal: A Community-Based Study in the Menoua Division in Cameroon

COVID-19, which was named in March 2020 as a global pandemic by the WHO, remains a serious public health threat worldwide. Despite the adoption of vaccines as an effective strategy to counter this pandemic, the vaccination rate in Cameroon is far lower than that planned by the Cameroonian government and its partners. The main objective of this study was to determine the factors limiting COVID-19 vaccine acceptance in the Menoua Division in the West Region of Cameroon. A community-based cross-sectional and analytical study was conducted between March and April 2022 in the Menoua Division. A pre-tested questionnaire was filled out by willing participants of more than 18 years old, and data were further expressed in order to estimate the knowledge of participants on COVID-19, vaccine status, and the factors associated with vaccine refusal. A Pearson test was performed in order to identify the associated factors, with a p-value < 0.05 considered as significant. A total of 520 participants with a mean age of 33.27 ± 12.78 were included. Most had a secondary education level (56.15%), and trade and informal sectors (34.04%) were the main occupations. Knowledge on COVID-19 was average, and it was significantly associated (p < 0.05) with gender and education level. The vaccination rate was 10%, which was six times less than the national target. A lack of information, confidence, and medicinal plant use were all factors significantly associated with vaccine refusal. This pioneer community-based study in Cameroon identified a lack of knowledge, confidence, and medicinal plant use as the leading factors limiting COVID-19 vaccine acceptance in Cameroon. Health authorities should therefore strengthen sensitization in order to tackle the lack of information and the misinformation among the target groups.

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Multilingual COVID-19 vaccination videos in NSW, Australia: a case study of cultural-responsiveness on social media

Multimodal communication via social media employed by governments as a COVID-19 communication strategy with multilingual populations hopes to alter behaviours and attitudes. However, there is presently no understanding about the responsiveness of these videos to the needs of culturally and linguistically diverse (CaLD) populations in Australia. This study aimed to analyse the cultural responsiveness of content in multilingual videos shared via a government social media page from NSW, Australia. A systematic search of videos shared between June 2021 and October 2021 was conducted. Using quantitative methods, 37 videos were analysed using a modified version of the Patient-oriented and culturally-adapted (POCA) healthcare translation model and readability indexes. Of these, 5/37 were classified as culturally responsive. The culturally responsive videos scored higher than those that were not culturally responsive. While credible sources, positive language and cultural symbols were observed in several of the videos, there was a lack of familiar experiences and economically viable vaccine uptake behaviours. Videos favoured generic examples of vaccine practices and failed to address concerns about vaccine eligibility, cost, and transport. All videos exceeded recommended readability indices for CaLD populations. Removing complex and abstract terminology and including familiar vaccine experiences could improve multilingual communication for CaLD communities.

Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above

This scientific review paper explores international and country-specific healthcare guidelines for non-communicable diseases with the highest burden among individuals aged 75 years and above. The study aims to identify the best vaccination practices and standardize healthcare practices to improve vaccination adherence in this vulnerable population. Given that older people are more prone to infectious illnesses and have higher rates of morbidity and mortality, vaccinations are essential for disease prevention. Despite the proven efficacy of vaccinations, adherence has plateaued in recent years, partly due to a lack of accessibility, public education, and variability in disease-specific guidelines. This paper highlights the need for a more robust and standardized international vaccination model to improve quality of life and reduce disability-adjusted life years among the elderly. The findings of this study call for further research to review the guidelines as more implementations are put in place, including non-English guidelines.

Addressing Unmet Needs in Vaccination for Older Adults in the Asia Pacific: Insights from the COVID-19 Pandemic

The impact of vaccinating the older population against vaccine-preventable diseases in terms of health, social and economic benefits has been increasingly recognised. However, there is a gap in the utilisation of vaccines worldwide. The population is ageing at an unprecedented pace in the Asia-Pacific (APAC) region, with the number of persons older than 65 years set to double by 2050 to around 1.3 billion. More than 18% of the population in Japan, Hong Kong, and China is over the age of 65 years. This highlights the importance of prioritising resources to address societal obligations toward the needs of the ageing generation. This review provides an overview of the challenges to adult vaccination in APAC, drivers to increase vaccination coverage, vaccination insights gained through the COVID-19 pandemic, and potential measures to increase the uptake of adult vaccines in the region.

Using the 5C model to understand COVID-19 vaccine hesitancy across a National and South Carolina sample

Vaccine hesitancy is a serious threat to global health; however, significant COVID-19 vaccine hesitancy exists throughout the United States. The 5C model, which postulates five person-level determinants for vaccine hesitancy - confidence, complacency, constraints, risk calculation, and collective responsibility - provides one theoretical way of understanding COVID-19 vaccine hesitancy. The present study examined the effects of these 5C drivers of vaccine behavior on early vaccine adoption and vaccine intentions above and beyond theoretically salient demographic characteristics and compared these associations across a National sample (n = 1634) and a statewide sample from South Carolina (n = 784) - a state with documented low levels of COVID-19 vaccination uptake. This study used quantitative and qualitative data collected in October 2020 to January 2021 from the MFour-Mobile Research Panel, a large, representative non-probability sample of adult smartphone users. Overall, the South Carolina sample reported lower COVID-19 vaccine intentions and higher levels of 5C barriers to vaccine uptake compared to the National sample. Findings further indicated that both demographic characteristics (race) and certain drivers of vaccine behavior (confidence and collective responsibility) are associated with vaccine trust and intentions across samples above and beyond other variables. Qualitative data indicated that COVID-19 vaccine hesitancy was driven by fears about the quick vaccine development, limited research, and potential side effects. Although there are some limitations to the cross-sectional survey data, the present study offers valuable insight into factors associated with early COVID-19 vaccine hesitancy across the United States.

Halal or Haram? The COVID-19 Vaccine Discussion Among Twitter users in Malaysia

Vaccine hesitancy is gaining attention due to the increasing spread of the COVID-19 pandemic in Malaysia. Malaysia is a majority Muslim country and religion has a significant influence on the acceptance or rejection of vaccines. This is clearly seen through the disagreement over the  halal status of vaccines. Social media has become a platform for discussion and dissemination of information and dis-information on vaccines. Thus, it has had a relatively significant influence on vaccine hesitancy among social media users. By analysing tweets from February 2020 to February 2021 using Twitter API, this paper highlights the discussion of COVID-19 vaccines' halal status on Twitter. This study focuses on the analysis of vaccination reluctancy among the Twitter users in Malaysia and found that the most prevalent theme from the discussion is the constructed religious narratives to justify scientifically misleading and false claims concerning vaccination represented on social media. This finding also calls for a deeper understanding of society's constructed knowledge concerning contemporary issues in the digital age on social media.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

Introduction

The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine.

Methods

A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder.

Results

The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001).

Discussion

The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Demographic Factors, Conspiracy Theories, and Beliefs Associated With COVID-19 Vaccine Hesitancy Among Pakistani Population: A Cross-Sectional Study

Introduction The coverage of coronavirus disease 2019 (COVID-19) immunization uptake has been impacted by the acceptance of regular vaccine uptake and, like many other vaccination attempts in the past, it also faces issues of vaccine hesitancy. Through this study, we hoped to assess the conspiracy theories and beliefs attached to the COVID-19 vaccination efforts in Pakistan Methods This study was conducted among the general population of Pakistan, aged 16 and above, from April 29 to May 29, 2021. The data was collected through English and Urdu questionnaires by a method of convenient sampling. A total of 600 participants were asked to fill in 34 questions pertaining to vaccine hesitancy and conspiracies. We used the Modified Kuppuswamy Socioeconomic Scale, Kuppuswamy Socioeconomic Scale, Conspiracy Mentality Questionnaire (CMQ), and Vaccine Conspiracy Belief Scale (VCBS) as our questions. Results A total of 591 participants responded to our questionnaire. The majority were females (56.7%), had an undergraduate degree (41.5%), and belonged to the upper middle socioeconomic class (40%). Factors like occupation (p=0.001), education (p=0.001), socioeconomic status (p<0.001), any family member who contracted coronavirus (p=0.016), source of knowledge (p=0.002), and total monthly income (p<0.001) were found to be statistically significant. Conclusion The findings of this study suggest that conspiracy theories and misinformation about vaccinations are prevalent in our region. They are influenced by propaganda and negative cultural values among the population To combat and restrict the spread of this problem, our study can provide useful data to develop more appropriate policy measures.

Surveillance and risk assessment of health screening for vaccine-preventable diseases among international students in Japan: A cross-sectional study in 2020

We conducted a cross-sectional study using a structured questionnaire in three major Japanese cities from August 03 to 24, 2020 to clarify the current situation of health checkups, including vaccine-preventable diseases (VPDs), among international students at Japanese universities (JUs) and Japanese language schools (JLSs). The total response rate was 36%: 69 JUs (31%) and 137 JLSs (39%). Over 90% of these institutions conducted chest X-ray screening for tuberculosis among their students, whereas only 24.6% of JUs and 15.3% of JLSs performed general blood tests for health screening. Only 14.5% and 2.2% of the JUs and JLSs, respectively, required the submission of vaccination or antibody certificates for admission. The difficulties in requesting vaccination certificates from international students are due to poor legal requirements and concerns about rising costs for schools. From 2017 to 2019, 183 international students, principally from East Asia and Southeast Asia, were infected with VPDs, particularly tuberculosis (99 cases) and varicella (71 cases). Whereas the majority of Japanese educational institutions screen international students for tuberculosis (TB) at admission, only a few institutions request proof of antibody testing relating to other VPDs or of vaccination. These findings will help formulate guidelines for checkups related to vaccination for international students required to protect the educational institutions in Japan from the spread of VPDs. In addition, providing multifaceted social support, including financial compensation for institutions and enhanced international students' health issues, would be helpful.

A Social Cognitive Theory Approach to Understanding Parental Attitudes and Intentions to Vaccinate Children during the COVID-19 Pandemic

The distribution of the COVID-19 vaccine represents a path towards global health after a worldwide pandemic. Yet, the U.S. response to the vaccination rollout has been politically polarized. The aim of this paper is to contribute to the understanding of the contextual factors that influence parents' attitudes towards health officials and their intention to vaccinate children, focusing on communication behaviors, personal factors, and geographic locations. We use Bandura's triadic reciprocal determinism (TRD) model which posits reciprocal influence between personal factors, environmental factors, and behaviors. We found that personal factors (having younger children and identifying as Republican partisans), and the behavioral factor of conservative news use were significantly related to more negative attitudes towards health officials and lower vaccination intentions. Conversely, Democrats and liberal news use were significantly related to warmer attitudes and greater vaccination intentions. The environmental factor of geographic location across four states with different partisan dynamics was not significantly related to attitudes and behavioral intentions. Results from a post-hoc analysis show that news media use and partisanship were the strongest correlates of parents' attitudes towards health officials. This evidence points to the politicization of the COVID-19 vaccine being a key consideration regarding vaccine uptake.

Nexus among big data analytics, environmental process integration and environmental performance: moderating role of digital learning orientation and environmental strategy

Purpose

This study aims to examine the influence of big data analytics (BDA) on environmental performance (ENP) in the post-COVID-19 context in Vietnam, as a developing country. In which, this study considers environmental process integration in accounting reports as a mediator variable. Furthermore, digital learning orientation (DLO) and environmental strategy (ES) are proposed as the moderator variables for relationships in the proposed model.

Design/methodology/approach

Data was collected by survey method via email with convenient sampling method. In total, 611 emails, including the survey, were sent to executive managers of Vietnamese manufacturing companies listed on stock exchanges. The final sample of 419 responses was used for analysis.

Findings

By using the partial least squares structural equation modeling, this study’s results elucidate that BDA positively affects ENP. Moreover, DLO positively moderates the nexus between BDA and environmental process integration in accounting reports, while ES plays a positive moderating role on the nexus between environmental process integration and ENP.

Practical implications

In terms of managerial implications, this paper mentions pretty attractive features of using modern technique and ENP. This research emphasizes the key role of the BDA for both reporting and accounting performance (e.g. environmental process integration and ENP) of the company. Thus, managers should examine implementing BDA when necessary to make accounting reports more transparent and modern, thereby enhancing the organization's ENP. Particularly, managers should focus on improving the organization's ENP indicators.

Originality/value

This study complements the ENP literature by showing a positive effect of BDA and environmental process integration on ENP. Additionally, this study’s results determine the efficacy of DLO and ES as well as their regulatory roles. Finally, this study was conducted to supplement empirical evidence on ENP in the post-COVID-19 context in developing countries, specifically Vietnam.

COVID-19 vaccine acceptance among pregnant women worldwide: A systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has led to the death of many people worldwide. The World Health Organization (WHO) has declared vaccine resistance as one of the greatest health threats in the world even before the COVID-19 epidemic. The aim of this study was to evaluate the acceptance of COVID-19 vaccine in pregnant women.

METHOD

We performed this systematic review and meta-analysis in accordance with the PRISMA guidelines. We applied the standard search strategy to the PubMed/Medline, Web of Science (ISI), Scopus, Science Direct, Cochrane Library, EMBASE, and EBSCO databases, and the Google Scholar search engine. Heterogeneity between studies was relatively high and therefore meta-analyses were performed based on random effects model with 95% CI using STATA version 16.

RESULTS

In 16 articles with a sample size of 19219 pregnant women, the acceptance of COVID-19 vaccine was estimated 53.46% (95%CI: 47.64%-59.24%). Subgroup analysis was performed based on continent (p = 0.796), data collection method (p = 0.450) and meta-regression based on the month of the study (P<0.001), and only meta-regression was significant based on the month of the study. The effect of some variables such as graviad (OR = 1.02 [95%CI: 0.90-1.16]), maternal age was (OR = 1.02 [95%CI: 0.93-1.11]) and history of influenza vaccination (OR = 0.87 [95%CI: 0.71-1.06]) on COVID-19 vaccine acceptance was evaluated, which was not significant.

CONCLUSION

The prevalence of COVID-19 vaccine acceptance in pregnant women was 53.46%, which was much lower than the general COVID-19 vaccination. Therefore, necessary interventions should be taken to increase the acceptance of the vaccine, address safety concerns and educate about it.

Social expectations and government incentives in Malaysia's COVID-19 vaccine uptake

High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals' expectations of others in their social groups towards vaccination predicts those individuals' vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual's reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.

Understanding determinants of COVID-19 vaccine hesitancy; an emphasis on the role of religious affiliation and individual's reliance on traditional remedy

BACKGROUND

The damage COVID-19 has caused interms of mortalities, economic breakdown and social disruption is immense. The COVID-19 vaccine has been one of the efficient prevention strategies so far in preventing the pandemic. However, the publics' hesitancy towards vaccines has enormously affected this task. With emerging research findings indicating that a substantial proportion of adults are hesitant about a vaccine for COVID-19, important work that identifies and describes vaccine hesitant individuals is required to begin to understand and address this problem.

OBJECTIVE

This study assessed public attitude towards COVID-19 Vaccine and identified important factors that lead to its hesitancy.

METHODS

A web and paper-based cross-sectional survey study was conducted from July 31 to August 12, 2021. The study participants are staffs and students at Jimma University. A total of 358 participants were selected using stratified simple random sampling and requested to fill a survey questionnaire. Binomial logistic regression analysis was done to identify factors associated with COVID-19 vaccine hesitancy.

RESULTS

Half of the participants were found to be hesitant to COVID-19 vaccine. The odds of becoming vaccine hesitant among middle income was two times more than those with lower income (AOR 2.17, 95% CI 1.05-4.5). Furthermore, respondent's extent of exposure was associated with vaccine hesitancy with the odds of becoming vaccine hesitant among those whose source of COVID-19 information is from four media sources (Social Media, Mass Media, Health care worker and Friends/family/Neighbor) being 74% lower (AOR .26, 95% CI .09-.69) than those with one media source. Concern towards vaccine side effect, vaccine effectiveness and having the belief to treat COVID-19 with traditional remedies were found to increase the odds of becoming vaccine hesitant by 31%, 42% and 37% respectively. Moreover, the association between side-effect concern and vaccine hesitancy was moderated by participant's religious affiliation.

Impact of vaccine hesitancy on secondary COVID-19 outbreaks in the US: an age-structured SIR model

BACKGROUND

The COVID-19 outbreak has become the worst pandemic in at least a century. To fight this disease, a global effort led to the development of several vaccines at an unprecedented rate. There have been, however, several logistic issues with its deployment, from their production and transport, to the hesitancy of the population to be vaccinated. For different reasons, an important amount of individuals is reluctant to get the vaccine, something that hinders our ability to control and-eventually-eradicate the disease.

MATERIALS AND METHODS

Our aim is to explore the impact of vaccine hesitancy when highly transmissible SARS-CoV-2 variants of concern spread through a partially vaccinated population. To do so, we use age-stratified data from surveys on vaccination acceptance, together with age-contact matrices to inform an age-structured SIR model set in the US.

RESULTS

Our results show that per every one percent decrease in vaccine hesitancy up to 45 deaths per million inhabitants could be averted. A closer inspection of the stratified infection rates also reveals the important role played by the youngest groups. The model captures the general trends of the Delta wave spreading in the US (July-October 2021) with a correlation coefficient of [Formula: see text].

CONCLUSIONS

Our results shed light on the role that hesitancy plays on COVID-19 mortality and highlight the importance of increasing vaccine uptake in the population, specially among the eldest age groups.

The lived experiences of a COVID-19 immunization programme: vaccine hesitancy and vaccine refusal

Background

The COVID-19 pandemic has resulted in a global health emergency and lock-down measures to curb the uncontrolled transmission chain. Vaccination is an effective measure against COVID-19 infections. In Malaysia amidst the national immunisation programme (NIP) which started in February 2021, there were rising concerns regarding the prevalence of vaccine hesitancy and refusal, and therefore, vaccine uptake among Malaysians. Although there are many quantitative studies on COVID-19 vaccination, the subjective experience of individuals was understudied. This study aims to explore the lived experiences of Malaysians regarding vaccine hesitancy and refusal, and facilitating factors that could enhance vaccine acceptance and uptake.

Methods

This qualitative study employed the hermeneutic phenomenological study design. Purposive sampling strategies were used to recruit Malaysians that had direct experiences with friends, family members and their community who were hesitating or refusing to accept the COVID-19 vaccines. A semi-structured interview guide was developed based on the expert knowledge of the investigators and existing literature on the topic. A series of focus group interviews (FGIs) was conducted online facilitated by a multidisciplinary team of experts. The group interviews were transcribed verbatim and analysed.

Results

Fifty-nine participants took part in seven FGIs. We found that “incongruence” was the overall thematic meaning that connected all the 3 main themes. These themes comprise firstly, the incongruence between the aims and implementation of the National Immunization Program which highlighted the gap between realities and needs on the ground. Secondly, the incongruence between Trust and Mistrust revealed a trust deficit in the government, COVID-19 news, and younger people’s preference to follow the examples of local vaccination “heroes”. Thirdly, the incongruence in communication showed the populace’s mixed views regarding official media and local social media.

Conclusions

This study provided rich details on the complex picture of the COVID-19 immunization program in Malaysia and its impact on vaccine hesitancy and refusal. The inter-related and incongruent factors explained the operational difficulty and complexity of the NIP and the design of an effective health communication campaign. Identified gaps such as logistical implementation and communication strategies should be noted by policymakers in implementing mitigation plans.

Approach of Pregnant Women from Poland and the Ukraine to COVID-19 Vaccination—The Role of Medical Consultation

There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnancy. The aim of this study is to describe the level of vaccination acceptance, to find the factors that most influence the decision to vaccinate, and to describe the scale of changes in vaccination acceptance influenced by medical information on the safety, efficacy, and benefits of vaccination among pregnant women. A total of 300 patients completed the questionnaire, including 150 in Poland and 150 in the Ukraine. The level of vaccination acceptance was assessed before and after medical consultation. There were 53 (35.3%) patients with the intention to get vaccinated in Poland and 25 (16.7%) in the Ukraine. After consultation with a physician, this increased to 109 (72.6%) in Poland and 69 (46%) in the Ukraine. The main factors influencing the acceptance of vaccinations were the fear of harming the foetus (OR-0.119, CI-0.039–0.324 p < 0.001), complications in pregnancy (OR-0.073 CI-0.023–0.197 p < 0.001), and limitations in the vaccination programme (OR-0.026 CI-0.001–0.207 p < 0.001). Medical information about the safety, effectiveness and benefits of vaccinations among pregnant women, provided during a medical visit, may increase the acceptance of vaccinations by 105.6%, as among Polish patients, and by 176%, as among pregnant women from the Ukraine.

Sharia (Islamic Law) Perspectives of COVID-19 Vaccines

The Coronavirus disease 2019 (COVID-19) pandemic has caused health, economic, and social challenges globally. Under these circumstances, effective vaccines play a critical role in saving lives, improving population health, and facilitating economic recovery. In Muslim-majority countries, Islamic jurisprudence, which places great importance on sanctity and safety of human life and protection of livelihoods, may influence vaccine uptake. Efforts to protect humans, such as vaccines, are highly encouraged in Islam. However, concerns about vaccine products’ Halal (permissible to consume by Islamic law) status and potential harm can inhibit acceptance. Fatwa councils agree that vaccines are necessary in the context of our current pandemic; receiving a COVID-19 vaccination is actually a form of compliance with Sharia law. Broader use of animal component free reagents during manufacturing may further increase acceptance among Muslims. We herein explain the interplay between Sharia (Islamic law) and scientific considerations in addressing the challenge of COVID-19 vaccine acceptance, particularly in Muslim populations.

Collective Value Promotes the Willingness to Share Pro-Vaccination Messages on Social Media in China: A Randomized Controlled Trial (Preprint)

Background

The proliferation of vaccine misinformation on social media has seriously corrupted the public’s confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed.

Objective

This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value.

Methods

We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6%) and experiment 2 (n=200, 44.4%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform’s randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2.

Results

The valid sample included 213 adults in experiment 1 (females: n=151, 70.9%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8%; single: n=131, 61.5%) and 171 adults in experiment 2 (females: n=106, 62.0%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3%; single: n=95, 55.6%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F_3,166=4.96, P=.03, η²=0.03). The reverse result was found for the willingness to share provaccination messages (F_3,165=6.87, P=.01, η²=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F_3,165=6.87, P=.01, η²=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95% lower limit confidence interval [LLCI] 0.41, 95% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F_3,166=5.96, P=.02, η²=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing.

Conclusions

Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey

INTRODUCTION

Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap.

METHODS AND MATERIALS

This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis.

RESULTS

The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe).

CONCLUSIONS

Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

Vaccine hesitancy and implications on childhood immunisation in Malaysia

Purpose

The World Health Organization identified vaccine hesitancy as one of the ten threats to global health in 2019. The purpose of this paper is to evaluate the implications and factors affecting parental decision on childhood immunisation in Malaysia.

Design/methodology/approach

This paper reviews literature on vaccine hesitancy and evaluation of factors affecting parental decision on childhood immunisation in Malaysia.

Findings

Vaccine hesitancy is a growing public health concern in Malaysia with factors such as influence of Internet and social media, personal choice and individual right, conspiracy theory, religious reasons and alternative medicine as among the influencing dynamics. An urban, educated demography operating within a postmodern medical paradigm compounds the diminishing value of vaccines.

Originality/value

This paper provides a comprehensive examination of vaccine hesitancy in Malaysia. Critical appraisal on personal choice over societal responsibility within an Asian/Muslim collectivist society has not been discussed in previous studies. The acceptance of homeopathy as an Islamic medicine alternative is peculiar to multi-ethnic, multi-cultural Malaysia.

Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians' acceptance of the COVID-19 vaccine and its associated factors.

METHODS

A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.

RESULTS

In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.

CONCLUSION

Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.

Factors Influencing Vaccine Hesitancy in China: A Qualitative Study

Vaccine hesitancy has become a significant issue. We aimed to elucidate the factors influencing vaccine hesitation in Chinese residents and to analyze and recommend promotional strategies and measures. In total, 92 Chinese residents from 10 provinces were interviewed using semi-structured face-to-face interviews following a predetermined survey framework in this qualitative study. We found trust in vaccine safety, access to professional advice, and vaccine price and effectiveness to be the main factors influencing vaccine hesitation. Additionally, residents in areas with a higher per capita GDP tend to receive more social support, believe that vaccination is beneficial and can prevent diseases, pay more attention to whether the vaccine is safe and has undergone various clinical trials, and are more likely to seek advice from individuals with vaccination experience as opposed to their counterparts in areas with a lower per capita GDP. Notably, as per capita GDP rises, individuals become more concerned about the price of vaccines. Measures such as clarifying vaccine safety and effectiveness, reducing self-funded vaccine prices, offering free vaccination for special groups, strengthening the publicity role of medical staff, and taking advantage of network platforms are essential to reduce vaccine hesitancy among Chinese residents.

Acceptance of COVID-19 Vaccine among Dental Professionals: A Cross-Sectional Study among Practitioners, Residents, and Students

Introduction:

The COVID-19 pandemic spread rapidly across the world, prompting governments to impose lengthy restrictions on both movement and trade. While lockdowns reduce the prevalence of COVID-19 disease, they may have a negative impact on the economy and job levels. Dental medicine has been one of the most severely impacted industries during this crisis. Dental professionals are exposed to environments with high levels of occupational hazards, additional risks of viral exposure, and transmission.

Methods:

We analyzed 705 anonymous questionnaires filled out by dentists, dental students, and postgraduate students about their willingness to consider a new SARS-CoV-2 vaccine.

Results:

Our findings show a statistically significant relationship between an individual's unemployment rate and their ability to be immunized with a SARS-CoV-2 vaccine.

Conclusion:

As part of the global vaccination program's alertness, these data may be used to forecast patterns in vaccine adoption or denial depending on economic burden during the COVID-19 pandemic by various industries.

The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review

Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to conduct a systematic review concerning the approach of pregnant women towards vaccination against COVID-19, with particular regard to determinants of vaccination acceptance. Materials and Methods: Articles were reviewed in which the aim was to evaluate—via a survey or questionnaire—the acceptance and decision to undergo vaccination against COVID-19. The articles were subjected to review according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Results: In various studies, the percentage of pregnant women accepting the COVID-19 vaccine was between 29.7% and 77.4%. The strongest factors co-existing with the acceptance of the COVID-19 vaccination in pregnancy were trust in the importance and effectiveness of the vaccine, explicit communication about the safety of COVID-19 vaccines for pregnant women, acceptance of other vaccinations such as those for influenza, belief in the importance of vaccines/mass vaccination in one’s own country, anxiety about COVID-19, trust in public health agencies/health science, as well as compliance to mask guidelines. The remaining factors were older age, higher education, and socioeconomic status. Conclusions: This review allowed us to show that geographic factors (Asian, South American countries) and pandemic factors (different threats and risks from infection) significantly influence the acceptance of vaccines. The most significant factors affecting acceptance are those related to public awareness of the risk of infection, vaccine safety, and the way in which reliable information about the need and safety of vaccines is provided. Professional and reliable patient information by obstetricians and qualified medical personnel would significantly increase the level of confidence in vaccination against COVID-19.

Dengue and COVID-19 infections in the ASEAN region: a concurrent outbreak of viral diseases

Member countries of the Association of Southeast Asian Nations (ASEAN) have faced dengue outbreaks for decades, and the region has one of the highest rates of dengue globally. Outbreaks continue to occur concurrently with the coronavirus disease 2019 (COVID-19) pandemic in the 10 ASEAN countries. Both infectious diseases pose a tremendous burden in these countries related to both infection control and the economy. Increases in the number of dengue cases occurred in part due to disruptions in the pathogen-host-vector relationship caused by changes in human behaviour in response to the COVID-19 pandemic. The spread of dengue was further aggravated by the implementation of lockdowns and social distancing policies. These measures limited the coverage of dengue preventive programs and delayed the medical management of both diseases due to co-infection and misdiagnosis. It is of the utmost importance for the population to remain aware of both diseases, and dengue vector control strategies must be devised to properly address outbreaks using digitalization and remote surveillance. Similarly, critical triage algorithms and further research are also needed to combat co-infection and misdiagnosis. Controlling the spread of COVID-19 though vaccination should also be undertaken to reduce the impact of the pandemic.

Discrepancies and Similarities in Attitudes, Beliefs, and Familiarity with Vaccination Between Religious Studies and Science Students in Malaysia: A Comparison Study

Little is known about the impact of religion on vaccine receptivity in Malaysia. Improved vaccine uptake is positively reflected in the reduction of vaccine-preventable diseases. This study aimed to explore and compare the attitudes, religious beliefs, and familiarity regarding vaccination between the religious studies and science students. A survey-based cross-sectional study was conducted between a convenient sample of students (N = 300) of religious studies and applied sciences in Kuantan, Malaysia. A new, face- and content-validated questionnaire was used for data collection. A total of 206 students responded to the questionnaire, giving a response rate of 86.6%. Overall, participants demonstrated positive attitudes towards vaccination (n = 185, 89.9%). Only a minority of respondents expressed an opposition to vaccination (n = 21, 10.2%). Religious factors (permissibility) of vaccines (n = 12, 57.1%) and harm associated with the vaccine (n = 13, 61.9%) were the most common reasons for not supporting vaccination among the non-supporters. Most (n = 135, 65.5%) respondents agreed that vaccination is parallel with the Islamic concept of protecting life and preventing harm. Almost half of the respondents (n = 98, 47.6%) admit to declaring "Fatwa" to oblige parents to vaccinate their children. Religious beliefs and safety issues surrounding immunisation were reported as the major barriers for the support of immunisation. Well-designed programs are recommended to reshape the religious beliefs and convictions among students toward vaccination.

Promoting coronavirus disease 2019 (COVID-19) vaccination among healthcare personnel: A multifaceted intervention at a tertiary-care center in Japan

Objective:

The coronavirus disease 2019 (COVID-19) vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). We examined their perceptions of the COVID-19 vaccine and implemented an intervention to increase vaccination uptake.

Design:

Before-and-after trial.

Participants and setting:

Healthcare personnel at a 790-bed tertiary-care center in Tokyo, Japan.

Interventions:

A prevaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. A multifaceted intervention was then implemented involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine. A postvaccination survey was also performed.

Results:

Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 533 (43.5%) expressed willingness to be vaccinated, 593 (48.4%) were uncertain, and 98 (8.0%) expressed unwillingness to be vaccinated. The latter 2 groups were concerned about the vaccine’s safety rather than its efficacy. After the intervention, the overall vaccination rate reached 89.7% (1,413 of 1,575), and 88.9% (614 of 691) of the prevaccination survey respondents answered “unwilling” to or “unsure” about eventually receiving a vaccination. In the postvaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (274 of 1,037, 26.4%).

Conclusions:

This multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

Non-EPI Vaccine Hesitancy among Chinese Adults: A Cross-Sectional Study

Vaccination against coronavirus disease 2019 (COVID-19) is paramount to curtailing the pandemic. However, the impact of the Non-Expanded Program on Immunization (non-EPI) and COVID-19 vaccine hesitancy on vaccine uptake among Chinese adults remain unclear. This study was an online survey performed in Eastern, Central, and Western China between February 2021 and March 2021 using proportional sampling (n = 7381). Adults aged ≥ 18 years were included, especially younger people (aged < 65). Vaccine hesitancy was assessed using the 3C model and relative scales; logistic regression was used to explore the factors affecting vaccination uptake; structural equation modeling was used to evaluate the correlations between variables. Overall, 67.6% and 24.7% of adults reported vaccine hesitancy toward the non-EPI and COVID-19 vaccines, respectively. Participants (66.3%) reported taking the vaccine mainly based on recommendations from medical staff. Vaccine-hesitant participants (60.5%) reported a fear of side effects as the deciding factor in vaccine rejection. Vaccine hesitancy interacted negatively with confidence (β = −0.349, p < 0.001) and convenience (β = −0.232, p < 0.001), and positively with complacence (β = 0.838, p < 0.001). Nonmedical personnel, adults who had previously received the influenza vaccine, and older people had lower vaccine hesitancy than their counterparts. Most Chinese adults have non-EPI but not COVID-19 vaccine hesitancy. Vaccine safety remains a concern.

Access to Vaccination Information and Confidence/Hesitancy Towards Childhood Vaccination: A Cross-Sectional Survey in China

Access to vaccination information could influence public attitudes towards vaccination. This study investigated the number and types of vaccination-related information sources, and estimated their associations with vaccine confidence and hesitancy in China. In January 2019, we conducted a cross-sectional survey in China, and 2122 caregivers with children <6 years completed self-administered questionnaires. Logistic regressions were used to assess associations between caregivers’ primary information sources and vaccine confidence/hesitancy. A majority (72%) of caregivers had multiple sources of vaccination-related information. The proportions of caregivers reporting professional sources, media, and peers as primary information sources were 81%, 63%, and 26%. Internal migrants were less likely to get information from professional sources; more educated and wealthier caregivers reported more information sources and were more likely to get information from media and peers. Caregivers who reported professional information sources had significantly higher odds of being confident about the safety of vaccines and lower odds of being hesitant toward vaccination than those who did not. Caregivers who reported the media as a primary information source had significantly higher odds of being hesitant toward vaccination than those who did not. To address vaccine hesitancy, it is essential to promote universal access to professional vaccination-related information sources, and to use the media to disseminate evidence-based information and clarify misinformation. Health communication should target internal migrants, and more educated and wealthier caregivers.

COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study

BACKGROUND

There is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019.

METHODS

In this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty.

FINDINGS

Between November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake.

INTERPRETATION

To our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence.

FUNDING

European Commission, Wellcome, and Engineering and Physical Sciences Research Council.

Bibliometric analysis of global scientific literature on vaccine hesitancy in peer-reviewed journals (1990-2019)

BACKGROUND

Vaccine hesitancy is a growing threat to national and global health security. The current study was undertaken to provide insights into the global scientific literature on vaccine hesitancy in peer-reviewed journals.

METHOD

The current study was a descriptive bibliometric study. A validated search strategy on vaccine hesitancy was implemented using SciVerse Scopus. Bibliometric indicators such as (1) annual growth of publications, (2) key players, (3) research themes, (4) pathogens/diseases encountered, (5) top-cited documents, and (6) annual growth of publications stratified by world region and by age category were presented. The study period was from 1990 to 2019.

RESULTS

Search strategy found 2791 documents. The h-index of the retrieved literature was 89. The leading journal was Vaccine (369; 13.2%%) followed by Human Vaccines and Immunotherapeutics (129; 4.6%). Authors from the USA led with 1125 (40.3%) followed by authors from Italy (234; 8.4%) and the UK (204; 7.3%). The US CDC led with 140 (5.0%) documents followed by Emory University (USA) (81, 2.9%). The list of active authors included six from the USA while the remaining were from France, Australia, and Canada. Research themes in the retrieved literature focused on influenza, human papillomavirus, and the role of parents in immunization of their children. The region of the Americas and the European region had the greatest share of publications and showed steep growth of publications lately. Vaccine hesitancy research on adolescents was most noticed after 2007 while that on children was present all the time but escalated lately. Titles/abstracts analysis indicated that 621(22.3%) documents focused on influenza, 392 (14.0%) focused on Human papillomavirus, and 292 (10.5%) focused on measles. The top-cited documents in literature published after 2015 focused on the definition and strategies to overcome vaccine hesitancy.

CONCLUSION

The last decade witnessed a noticeable increase in the number of publications. Influenza vaccine and parental concerns about the human papillomavirus vaccine were the main focus of the retrieved literature. Information on vaccine hesitancy needs to be collected from all countries to build a better coalition against the anti-vaccination groups. Re-building trust in vaccines requires targeting parents by providing adequate information on the vaccines.

Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia

HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.