COVID-19 Vaccine Acceptance: We Need to Start Now

Fielding vaccines-challenges and opportunities in outbreaks, complex emergencies, and mass gatherings

With the recent COVID-19 pandemic, the importance of vaccine development, distribution, and uptake has come to the forefront of the public eye. Effectively fielding vaccines during an emergency-whether that emergency is a result of an infectious disease or not-requires an understanding of usual vaccine-related processes; the impact of outbreak, complex emergencies, mass gatherings, and other events on patients, communities, and health systems; and ways in which diverse resources can be applied to successfully achieve needed vaccine uptake. In this review, both the emergency setting and briefly vaccine product design are discussed in these contexts in order to provide a concise source of general knowledge from experts in fielding vaccines that can aid in future vaccine ventures and increase general awareness of the process and barriers in various settings.

Healthcare Workers and Nonhealthcare Workers Pro-Vaccination Attitude and Its Associated Factors towards COVID-19 Vaccine Globally: A Systematic Review and Meta-Analysis

Introduction

Coronavirus disease 2019 (COVID-19) pandemic has not been managed and controlled globally. The aim of this systematic review and meta-analysis were to determine the global pro-vaccination attitude and associated factors towards COVID-19 vaccine among healthcare workers (HCWs) and nonhealthcare workers (non-HCWs).

Methods

Different databases such as PubMed, Scopus, EMBASE, and Google Scholar were used. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 flowchart diagram and PRISMA checklist were used for study screening, selection, and inclusion into this systematic review and meta-analysis. Newcastle-Ottawa Scale (NOS) quality assessment criteria for cross-sectional studies were used to assess the included articles.

Results

A total of 51 studies were included into this systematic review and meta-analysis. The meta-analysis revealed that the global pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine among both HCWs and non-HCWs was 61.30% (95%CI: 56.12, 66.47, I 2 = 99.8%: p=0.000). Subgroup analysis showed that the global pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine was the lowest (59.77%, 95%CI (51.56, 67.98); I 2 = 99.6%, p=0.000) among the HCWs participants and the highest (62.53%, 95%CI (55.39, 69.67); I 2 = 99.8%, p=0.000) among the non-HCWs participants and the lowest (54.31%, 95%CI (43, 65.63); I 2 = 99.5%, p=0.000) for sample size <700 and the highest (66.49%, 95%CI (60.01, 72.98); I 2 = 99.8%, p=0.000) for sample size >700; the lowest (60.70%, 95%CI (54.08, 67.44); I 2 = 93.0%, p=0.000) for studies published in 2020 year and the highest (61.31%, 95%CI (55.93, 66.70); I 2 = 99.8%, p=0.000) for the studies published after 2020 years. From this systematic review, factors significantly associated with pro-vaccination attitude towards COVID-19 vaccine among HCWs were such as age, gender, race, work experience, home location, having no fear of injections, being a non-smoker, profession, presence of chronic illnesses, allergies, confidence in pharmaceutical companies, history of taking influenza vaccine, vaccine recommendation, perceived risk of new vaccines, perceived utility of vaccine, receiving a seasonal flu vaccination in the last 5 years, working in a private hospital, a high perceived pandemic risk index, low vaccine harm index, high pro-socialness index, being in close contact with a high-risk group, knowledge about the virus, confidence in and expectations about personal protective equipment, and behaviors. The level of positive attitude towards COVID-19 vaccine among non-HCWs ranged from 21.40% to 91.99%. Factors associated with the attitude towards COVID-19 vaccine among non-HCWs were such as age, gender, educational level, occupation, marital status, residency, income, ethnicity, risk for severe course of COVID-19, direct contact with COVID-19 at work, being a health profession, being vaccinated against seasonal flu, perceived benefits, cues to actions, having previous history of vaccination, fear of passing on the disease to relatives, and the year of medical study, studying health-related courses, COVID-19 concern, adherence level to social distancing guidelines, history of chronic disease, being pregnant, perceived vaccine safety, having more information about vaccine effectiveness, mandatory vaccination, being recommended to be vaccinated, lack of confidence in the healthcare system to control epidemic, and belief in COVID-19 vaccines protection from COVID-19 infection.

Conclusion

This meta-analysis revealed that the global estimated pooled prevalence of pro-vaccination attitude towards COVID-19 vaccine among both HCWs and non-HCWs was unsatisfactory. Globally, there is a need for a call for action to cease the crisis of this pandemic.

Mapping the Prevalence of COVID-19 Vaccine Acceptance at the Global and Regional Level: A Systematic Review and Meta-Analysis

Despite the availability of effective and safe vaccines, the acceptance of COVID-19 vaccination is suboptimal. In this meta-analysis we quantified the prevalence estimates of COVID-19 vaccine acceptance with a specific focus on worldwide geographical differences. We searched PubMed, Scopus, Web of Science and PsycInfo up to April 2021 (PROSPERO ID: CRD42021235328). Generalized random-effects linear models with a logit link were used to calculate the pooled estimated rate of vaccine acceptance at both the global and regional level. A meta-regression analysis was performed to assess the association between COVID-19 vaccine acceptance and various characteristics of the studies. Overall, 71 articles yielding 128 prevalence estimates were included. The pooled prevalence of COVID-19 vaccination acceptance rate was 66% (95% CI: 61-71%). This varied by geographic area, ranging from 36% (95% CI: 18-60%) in Africa to 83% (95% CI: 82-84%) in Oceania, and there was high variability between countries (15.4% Cameroon-100% Bhutan). Meta-regression analysis showed that studies that investigated COVID-19 vaccination intentions using multiple choice/scoring gave a vaccine acceptance prevalence lower than studies with only two possible answers (yes/no) (ß: -1.02 95% CI: -1.41 to -0.63). Despite some variation in the estimates, the results showed that one in three people may refuse/delay COVID-19 vaccination.

COVID-19 Vaccine Acceptance and Its Risk Factors in Iranian Health Workers 2021

Background

Ensuring vaccine acceptance in societies is a growing challenge for healthcare systems worldwide. This study aimed to identify factors associated with vaccine acceptance rates.

Methods

This cross-sectional study was conducted as a national web-based survey from February 9^th-13^th, 2021, just before the release of the COVID-19 vaccine in Shiraz, Iran. Independent variables included age, gender, occupation, history of COVID-19 infection, underlying diseases, and source of information. The willingness to be vaccinated was the dependent variable. A logistic regression analysis was performed to determine the relationship between different variables and the willingness to receive the COVID-19 vaccine. The significance level was set at less than 0.05. The data were analyzed using SPSS software version 21.

Results

Of 2,699 healthcare respondents, 70.3% indicated a willingness to receive the COVID-19 vaccine, of whom 49.2% preferred to receive a foreign vaccine and 24.68% desired to receive an Iranian vaccine. The women were more willing to receive the vaccine (67.6%) than the men (78.2%). Based on the results of logistic regression, gender (P<0.001) and job (P=0.005) were the most important associating factors to the willingness to receive the COVID-19 vaccine.

Conclusion

Although the majority of participants were willing to receive the COVID-19 vaccine, 29.6% were not yet ready. Women's healthcare providers were more hesitant to recommend the vaccine. As a result, the findings of this study can help policymakers and decision-makers in the field of health, treatment, and prevention of COVID-19 in raising the level of vaccination awareness among healthcare workers.

Parental Perspectives on Immunizations: Impact of the COVID-19 Pandemic on Childhood Vaccine Hesitancy

Childhood vaccine hesitancy has been studied extensively before the COVID-19 pandemic. The pandemic presented new barriers to pediatric vaccinations. Furthermore, the development of COVID-19 vaccines has complicated factors underlying vaccine hesitancy. We performed a cross-sectional mobile phone-based survey at Children's Hospital Los Angeles querying parents regarding perspectives on vaccines before and during the pandemic. Our primary aim was to understand the impact of the pandemic on routine childhood vaccine hesitancy. Secondarily, we examined intent to vaccinate, COVID-19 vaccine hesitancy, and key contributing demographic factors. Among 252 participants, we found overall increased childhood vaccine hesitancy (p = 0.006), increased risk perception (p = 0.006), and unchanged vaccine confidence during the COVID-19 pandemic. Increased hesitancy did not translate into decreased intent to vaccinate with routine childhood vaccines or influenza vaccines. During the pandemic, households with higher income (50-99 K, > 100 K) correlated with decreased routine childhood vaccine hesitancy, while Hispanic ethnicity and African American race had increased risk perception. For COVID-19 vaccine hesitancy, households with higher income (> 100 K) correlated with decreased hesitancy, while non-White ethnicity and race had increased risk perception. We found that routine childhood vaccine hesitancy increased during the COVID-19 pandemic, mainly due to increased risk perception. Key contributing demographic factors behind both childhood vaccine hesitancy and COVID-19 vaccine hesitancy included household income and race. Understanding factors behind routine childhood vaccine hesitancy is crucial to maintaining pediatric vaccination rates and promoting vaccine confidence during and after the COVID-19 pandemic.

Parental Perspectives on Immunizations: Impact of the COVID-19 Pandemic on Childhood Vaccine Hesitancy

Childhood vaccine hesitancy has been studied extensively before the COVID-19 pandemic. The pandemic presented new barriers to pediatric vaccinations. Furthermore, the development of COVID-19 vaccines has complicated factors underlying vaccine hesitancy. We performed a cross-sectional mobile phone-based survey at Children's Hospital Los Angeles querying parents regarding perspectives on vaccines before and during the pandemic. Our primary aim was to understand the impact of the pandemic on routine childhood vaccine hesitancy. Secondarily, we examined intent to vaccinate, COVID-19 vaccine hesitancy, and key contributing demographic factors. Among 252 participants, we found overall increased childhood vaccine hesitancy (p = 0.006), increased risk perception (p = 0.006), and unchanged vaccine confidence during the COVID-19 pandemic. Increased hesitancy did not translate into decreased intent to vaccinate with routine childhood vaccines or influenza vaccines. During the pandemic, households with higher income (50-99 K, > 100 K) correlated with decreased routine childhood vaccine hesitancy, while Hispanic ethnicity and African American race had increased risk perception. For COVID-19 vaccine hesitancy, households with higher income (> 100 K) correlated with decreased hesitancy, while non-White ethnicity and race had increased risk perception. We found that routine childhood vaccine hesitancy increased during the COVID-19 pandemic, mainly due to increased risk perception. Key contributing demographic factors behind both childhood vaccine hesitancy and COVID-19 vaccine hesitancy included household income and race. Understanding factors behind routine childhood vaccine hesitancy is crucial to maintaining pediatric vaccination rates and promoting vaccine confidence during and after the COVID-19 pandemic.

The Acceptance Rate Toward COVID-19 Vaccine in Africa: A Systematic Review and Meta-analysis

Background: The Coronavirus Disease 2019 (COVID-19) pandemic remains serious public issue. COVID-19 vaccine is a vital strategy to prevent this critical pandemic. However, unwillingness to take this vaccine are key barriers to manage the COVID-19 pandemic. The control of this pandemic will depend principally on the people acceptance of COVID-19 vaccine. Therefore, this systematic review and meta-analysis was intended to determine the acceptance rate toward COVID-19 vaccine in Africa. Methods: African Journals OnLine, PubMed, Cochrane Review, HINARI, EMBASE, Google Scholar, Web of Science, and Scopus were used to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used for this study. Random-effect model, a funnel plot, Egger's test, I 2 statistic, subgroup analysis was done. The study was performed by using a STATA version 11 statistical software. Results: A total of 22 studies with 33,912 study participants were included in this systematic review and meta-analysis. From this finding, the pooled prevalence of acceptance toward COVID-19 vaccine among adults in Africa was 48.93% (95% CI: [39.49, 58.37]). The subgroup analysis revealed that the pooled prevalence of COVID-19 vaccine acceptance among adults in Africa was highest (66.03%, 95% CI [62.84, 69.22]) in Southern Africa, and Lowest (24.28%, 95% CI [3.26, 45.30]) in Northern Africa. Conclusion: This study showed that the estimate of the pooled prevalence of acceptance toward COVID-19 vaccine among adults in Africa was very low. All concerned bodies should be actively involved to improve the acceptance rate of COVID-19 vaccine.

The Willingness to Receive COVID-19 Vaccine and Its Associated Factors: "Vaccination Refusal Could Prolong the War of This Pandemic" - A Systematic Review

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, spreads globally, since its declaration by the World Health Organization (WHO) as a COVID-19 pandemic on March 11, 2020. COVID-19 vaccine is a crucial preventive approach that can halt this pandemic. The present systematic review was aimed to assess the level of willingness to receive COVID-19 vaccine and its associated factors.

METHODS

A comprehensive literature search was conducted by using various online databases such as PubMed/MEDLINE, HINARI, EMBASE, Google Scholar, Web of Science, Scopus, African journals, and Google for grey literature which were used to search the related articles up to the period of May 08, 2021.

RESULTS

The overall rate of participants' willingness to receive the COVID-19 vaccine was ranged from 27.7% to 91.3%, which was from Congo and China, respectively. Factors such as age, educational status, gender, income, residency, occupation, marital status, race/ethnicity, perceived risk of COVID-19, trust in healthcare system, health insurance, norms, attitude towards vaccine, perceived benefit of vaccine, perceived vaccine barriers, self-efficacy, up-to-date on vaccinations, tested for COVID-19 in the past, perceived efficacy of the COVID-19 vaccination, recommended for vaccination, political leaning, perceived severity of COVID-19, perceived effectiveness of COVID-19 vaccine, belief that vaccination makes them feel less worried about COVID-19, believing in mandatory COVID-19 vaccination, perceived potential vaccine harms, presence of chronic disease, confidence, COVID-19 vaccine safety concern, working in healthcare field, believing vaccines can stop the pandemic, fear about COVID-19, cues to action, COVID-19 vaccine hesitancy, complacency, and receiving any vaccine in the past 5 years were associated with the willingness of receive COVID-19 vaccine.

CONCLUSION

There were insufficient levels of willingness to receive COVID-19 vaccine, and several factors were associated with it. Health education should be provided concerning this vaccine to improve the willingness of the community.