COVID-19 vaccine hesitancy among medical students

The effect of experts on attitude change in public-facing political science: Scientific communication on term limits in the United States

How can scientists best inform the public and change attitudes? Does the message or the messenger matter more? We test the effect of scientific expert messengers and messages in a preregistered, nationally representative survey experiment in the United States. Consistent with our hypotheses, scientists can move public attitudes in areas where knowledge is based on a non-ideological misperception to a greater extent than the same science-based message from another source. Although we focus on political science as a field and Congressional term limits in the United States as a topic area, our findings have broader implications for science communication with policymaking relevance given the persistence of misperceptions among the public across all natural and social science research fields.

Correlates of and barriers to COVID-19 vaccine initiation and intention among US college students

OBJECTIVE

To examine correlates of and barriers to COVID-19 vaccine initiation and intention among college students.

PARTICIPANTS

1,171 students attending a public university in the South.

METHODS

Multivariate logistic regression was used to assess the correlates of vaccine intention and initiation. Reasons for pursuing or foregoing vaccination were analyzed qualitatively using an inductive approach.

RESULTS

Among respondents, 44% had initiated vaccination, 38% intended to be vaccinated, and 18% were unsure about/unwilling to be vaccinated. Vaccine initiation and intention were both associated with 2019-2020 seasonal flu vaccination and political ideology, with conservative-leaning students having lower odds of vaccine initiation and of intention relative to liberal-leaning students. The most common reasons for vaccine initiation/intention and for vaccine hesitancy differed in frequency by political ideology.

CONCLUSION

The most effective vaccine promotion strategies may be those tailored to different social groups, virus-related beliefs/perceptions, and the specific concerns of vaccine hesitant students.

Association between friends' hesitancy and personal COVID-19 vaccine hesitancy among Chinese medical staff

COVID-19 vaccine hesitancy remains problematic among healthcare workers. Social network influences may shape vaccine decision-making, but few studies have examined this in this critical workforce. We assessed the relationship between friends' COVID-19 vaccination attitudes and personal hesitancy among Chinese healthcare personnel. In December 2022-January 2023, a cross-sectional online survey was conducted at a tertiary hospital in China using WeChat. Of the 1832 healthcare personnel who were invited to answer the structured questionnaire, 613 (33.5%) samples had valid data for data analysis. Logistic regression examined the association between friends' hesitancy and participants' own hesitancy, adjusting for confounders. Of 613 healthcare workers included, 266 (43.4%) were hesitant. Those with hesitant friends had 6.34 times higher adjusted odds of hesitating themselves versus those without hesitant friends (95% CI 2.97-13.52). Strong associations persisted across subgroups. Chinese healthcare workers' COVID-19 vaccination hesitancy was highly influenced by perceived friends' attitudes. Fostering pro-vaccine social norms through trusted peer networks could help promote vaccine acceptance in this critical workforce.

Insight into pharmacy students' perspectives on mandatory COVID-19 vaccines in schools and healthcare settings

Background

The COVID-19 pandemic has had an extreme global impact, transforming our daily lives, educational systems, and healthcare systems. Healthcare workers' views on mandatory vaccination and experience with vaccines may play a pivotal role in vaccination rates and public health policy.

Objectives

The purpose of this study is to uncover the perspectives of pharmacy students, at Xavier University of Louisiana, concerning COVID-19 vaccination mandates in educational institutions and healthcare environments, specifically the ethical, legal, and logistical dimensions. Furthermore, it will also assess the varying perceptions of vaccine safety and its impact on herd immunity while analyzing demographic characteristics.

Design

A questionnaire survey.

Methods

This cross-sectional study was conducted among students at Xavier University of Louisiana College of Pharmacy. Data were collected from the students using an online, anonymous questionnaire system named QualtricsXM. The survey was distributed to all 291 XULACOP students through email, text message, and GroupMe as a web link or QR code from August 25th to August 31st, 2023. Demographic data collected in the survey included age range, gender, and race/ethnicity. The 16-question survey assessed the students' understanding, opinions, and experiences regarding COVID-19 vaccines and mandates.

Results

The study sample included 151 students, reflecting a 52% response rate. Approximately, half of the study respondents believe the vaccine should be mandatory for the public, which was associated with opinions about students believing COVID-19 vaccines should be mandatory for school admissions were seven times more likely (OR = 7.33) and students believing mandatory vaccination infringes on personal freedom were 26% less likely (OR = 0.26) to support mandatory COVID-19 vaccines for the public(p = 0.000). When analyzing demographic characteristics, there was a significant difference in outcome between Black and non-Black students in their belief about mandatory vaccination for herd immunity (p = 0.016).

Conclusion

The findings of this study indicate that half of the students support making the vaccine mandatory for the public. However, significant concerns about personal freedom and individual rights were expressed by those who opposed this view. Varying pharmacy student opinions among demographic groups on vaccine mandates and understanding the factors influencing these differences can offer valuable insights into public health policy.

Socioeconomic determinants of COVID-19 vaccine acceptance

The aim of the paper is to evaluate the relative importance of the set of socioeconomic characteristics of population on collective decision on COVID-19 vaccine acceptance. We apply cross-section OLS methods to the municipal-level non-survey data for 145 municipalities in Serbia, on the COVID-19 vaccination rate and socioeconomic characteristics of the population, to evaluate the determinants of cross-municipal variation in vaccine uptake decision. Using the estimated coefficients from the OLS regressions, we apply the standardized beta method to evaluate the relative importance of each factor. Vaccine acceptance in municipalities rises with the average level of education (especially in the female population), age and employment, while being negatively linked to religiosity of people and the proportion of rural population. We also find some evidence on the positive impact of the overall trust in government. Education level has the single largest impact, shaping around 37% of (explained) variation in the vaccination rate across municipalities, a rise in the proportion of people with higher degree by 1% being associated with increase in vaccination rate by 0.36%. Age of population explains 21%, urban-rural structure 13% and religiosity 11% of variation in vaccine acceptance, while employment status and trust in government each explain around 9% of variation in vaccine uptake across municipalities. Effective vaccination promotion strategy should be focused on younger, less-educated, unemployed cohorts, as well as on rural areas and should involve representatives of mainstream religions. Fostering education and strengthening trust in government are some of the key structural factors that may promote efficient collective behaviour in this respect.

Medical Students' Attitudes Toward the COVID-19 Vaccine and Medical School Vaccine Education: A Survey Study

OBJECTIVE

The aim of this study is to investigate how demographic factors influence medical students' attitudes toward COVID-19 vaccines and their perceptions of vaccine education in medical school curricula.

METHODS

A 28-question anonymous online survey was distributed to 640 medical students at one academic medical institution. Individual attitudes toward vaccines were evaluated using a 5-point Likert scale. Responses were tested for association with various demographic factors using the Chi-square test or Fisher's exact test.

RESULTS

Two-hundred and forty-four responses out of 640 total surveyed revealed that 97.9% of the students had received at least one COVID-19 vaccine, 68.44% supported mandatory vaccinations, 16.81% did not believe vaccination protects others from getting sick, and 66.4% supported vaccine personal choice, with men showing a statistically stronger belief than women (p=0.0046). Approximately 25.1% of the students reported not receiving sufficient vaccine education in medical school and only 12.4% of all students considered medical school curricula as their most trusted source of vaccine information. Moreover, 8.6% of the students would not encourage patients to receive the COVID-19 vaccine and 8.2% were uncomfortable discussing patients' concerns. Unvaccinated students were more likely to not encourage patients to receive the vaccine (p<0.0001) and were more inclined to believe that acquiring natural immunity was preferable to vaccination (p<0.0001). One hundred percent of very conservative students, 97.8% of slightly conservative students, and students associated with any religion displayed statistical significance in endorsing vaccine personal choice (p=<0.0001), particularly among Christians (p=<0.0001). In contrast, 28% of very liberal and 48.3% of slightly liberal students agreed (p<0.0001). Additionally, the majority of liberal students agreed vaccines prevent the spread of disease while only 75% of conservative, independent, and neutral students agreed (p<0.001).

CONCLUSION

Despite high compliance, this cohort significantly demonstrated concern toward the COVID-19 vaccine, particularly those who were unvaccinated, had conservative political associations, and belonged to certain religious groups. These findings suggest identifying factors that impede medical education and an understanding of vaccines in order to improve physician training. We recommend an expanded medical curriculum to address these issues.

Vaccination Education Deficits and Vaccine Hesitancy Among Healthcare Students in Japan: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Healthcare professionals' (HCPs') accurate knowledge of and positive attitudes toward immunization greatly influence society's acceptance of it. Early and appropriate immunization education for HCP students is vital. This study aimed to understand current immunization education and vaccine hesitancy among medical, nursing, and pharmacy students in Japan.

METHODS

An anonymous self-administered online questionnaire was administered to final-year medical, nursing, and pharmacy students in Japan between 6 and 31 March 2023. Survey items assessed current immunization education, preparedness for clinical practice, immunization knowledge, and the degree of vaccine hesitancy.

RESULTS

Overall, 525 students (127 (24.2%) medical, 252 (48.0%) nursing, and 146 (27.8%) pharmacy) responded, of whom 39.8% raised concerns regarding new vaccine risks (24.4%,15.9%, and 23.3%, respectively; p = 0.22) and adverse effects (14.2%, 12.7%, and 17.1%, respectively; p = 0.57), including trust in government information (61.4%, 50/4%, and 56.8%, respectively; p = 0.337) or recommended vaccines (57.5%, 4.7%, and 43.8%, respectively; p = 0.113). Preparedness for future clinical practice varied significantly among schools, with medical students (54%) feeling more prepared compared to nursing (34.3%) and pharmacy students (39.1%) (p < 0.001). The average correct immunization knowledge rate was 59.9%, with significant differences between schools (medical 62.7%, nursing 57.6%, and pharmacy 59.6%; p < 0.001). There was no significant correlation between knowledge level and self-assessed preparedness (r = 0.066, p = 0.132). The HCP students wished to receive more immunization education and sought improvements in comprehensive knowledge, communication skills, and practice-based content.

CONCLUSIONS

For Japan's HCP students, the enhancement of immunization education focusing on hesitancy and risk-benefit communication is necessary.

COVID-19 knowledge, attitudes, and behaviors of STEM vs. non-STEM college students in Central Appalachia in 2021, a student-led project

Background: The COVID-19 pandemic has provided the general public with an understanding of scientific processes and health systems surrounding vaccination in real-time. This report assesses responses of college students in a regional university to the Centers for Disease Control and Prevention's (CDC) Knowledge, Attitudes, and Behaviors (KAB) survey in the spring of 2021. Methods: Participants were categorized based on study major: Science, Technology, Engineering and Math (STEM), non-STEM, or health science disciplines. Chi-square tests were used to compare vaccination beliefs between groups. Results: 632 respondents were included in the final analysis. STEM students were the least likely to agree that vaccinated individuals should not need masks (21%) compared to non-STEM (42%) and health science majors (37%). 51%, 45%, and 35% of STEM, non-STEM, and health science students were vaccinated respectively. No statistically significant differences were noted between groups. Conclusions: Vaccine hesitancy was similar in all students. Area of study did not impact vaccine behaviors.

A scoping review of COVID-19 vaccine hesitancy: refusal rate, associated factors, and strategies to reduce

Objective

This study aimed to investigate the evidence regarding vaccine hesitancy including refusal rate, associated factors, and potential strategies to reduce it.

Methods

This is a scoping review. Three main databases such as PubMed, Scopus, and Web of Science were searched from 1 January 2020 to 1 January 2023. All original studies in the English language that investigated one of our domains (vaccine hesitancy rate, factors associated with vaccine hesitancy, and the ways/interventions to overcome or decrease vaccine hesitancy) among the general population were included in this study. The data were charted using tables and figures. In addition, a content analysis was conducted using the 3C model of vaccine hesitancy (Confidence, Complacency, and Convenience) that was previously introduced by the WHO.

Results

Finally, 184 studies were included in this review. Of these, 165, 181, and 124 studies reported the vaccine hesitancy rate, associated factors, and interventions to reduce or overcome vaccine hesitancy, respectively. Factors affecting the hesitancy rate were categorized into 4 themes and 18 sub-themes (contextual factors, confidence barriers, complacency barriers, and convenience barriers).

Conclusion

Vaccine hesitancy (VH) rate and the factors affecting it are different according to different populations, contexts, and data collection tools that need to be investigated in specific populations and contexts. The need to conduct studies at the national and international levels regarding the reasons for vaccine refusal, the factors affecting it, and ways to deal with it still remains. Designing a comprehensive tool will facilitate comparisons between different populations and different locations.

COVID-19 vaccine hesitancy among medical students, health professionals, and health care workers: an umbrella review

Vaccination provides great protection against several infections, including coronavirus disease 2019 (COVID-19). However, the endeavor faces multiple context-specific problems that affect its uptake, leading to vaccine hesitancy. Vaccine hesitancy is a focal barrier to the success of COVID-19 vaccination programs. This umbrella review aimed to present a summary of global data regarding vaccine hesitancy and acceptance rates among medical students, health professionals, and health care workers. In this regard, two databases, PubMed and Scopus, were selected for data retrieval and analysis. A search term and an inclusion/exclusion criterion were applied to summarize the findings of existing systematic reviews. A pooled prevalence of vaccine acceptance and hesitancy with 95% confidence interval (CI) was taken as a prerequisite for this review. The results found a high percentage of COVID-19 vaccination ranging from 13.1% (95% CI, 6.9%-20.9%) to 46% (95% CI, 0.38%-0.54%), while the percentage of acceptance varied from 46% (95% CI, 37%-54%) to 83.0% (95% CI, 71%-96%) among medical students, health professionals, and health care workers. This umbrella review found a high percentage of COVID-19 vaccine hesitancy among medical students, health professionals, and health care workers. Further studies analyzing the determinants of vaccine hesitancy are important predictors for successful vaccination programs at the global level.

Association between beliefs in medical conspiracy theories and health behaviors among medical and healthcare students. Implications for professional practice

BACKGROUND

While conspiracy theories cover many different themes, medical conspiracy theories (MCTs) have become particularly prevalent in modern societies. As beliefs in MCTs can become a source of "infodemics", influence individual health behaviors and cause distrust in medical institutions and personnel, healthcare workers must find ways to overturn patients' conspiracy thinking. However, as the medical world is not free of these beliefs, in this study, we investigated beliefs in MCTs among medical and health science students and their association with reported health behaviors.

METHODS

Our sample was derived from a self-administered, anonymized, computer-assisted web survey conducted among 1,175 medical and health science students enrolled at the Poznan University of Medical Sciences, Poland.

RESULTS

From a set of twenty different MCTs, one-third of students rejected all of them, 18% believed in one, 15% in two, 10% in three, and 24% supported four or more conspiracy theories. In addition, many students were hesitant or unsure about MCTs. We also found that nursing and midwifery students were the most likely to believe in MCTs, while medical and dental students were the least supportive. Support for MCTs was higher among students in the early years of their studies and who declared themselves religious and conservative. This study also highlights the association between students' support for MCTs and their reported health behaviors, including avoiding vaccinations, using alternative medicine, taking vitamin C, or using social media as an essential source of health information.

CONCLUSIONS

As medical and health science students are prone to conspiratorial thinking, they should be trained to act as a trusted and reliable source of medical information, to mitigate conspiratorial beliefs, and to act as role models for their patients and society, effectively shaping health behaviors in the population.

Cultural and social attitudes towards COVID-19 vaccination and factors associated with vaccine acceptance in adults across the globe: A systematic review

OBJECTIVES

To identify and synthesise evidence on cultural and social attitudes towards coronavirus disease 2019 (COVID-19) vaccination and factors associated with vaccine acceptance in the adult population.

DESIGN

Systematic review.

DATA SOURCES

Six electronic databases were searched (CINAHL, Coronavirus Research Database, Embase, MEDLINE, Nursing and Allied Health Database, and Web of Science Core Collection). Additional studies were identified through Google Scholar and hand searching the reference lists of all studies included in the review.

METHOD

The searches were conducted to identify all relevant studies published in English, from December 2019 to December 2021. The Critical Appraisal Skills Programme (CASP) and Appraisal tool for Cross-Sectional Studies (AXIS tool) were used to critically appraise the quality of included studies. Data were extracted and synthesised narratively.

RESULTS

1260 records were identified, of which 38 studies were included in the review. Low COVID-19 vaccination acceptance rates were found among young people, females, non-medical students, and even some healthcare workers, which were associated with misinformation obtained through social media platforms, unknown side effects, questionable conspiracy theories, and doubts about efficacy and safety. Higher COVID-19 vaccination acceptance rates were due to recommendations from healthcare professionals and government sources, and the perceived increased risk of contracting COVID-19.

CONCLUSION

COVID-19 vaccine acceptance varies across the globe. To increase the acceptance rate of the COVID-19 vaccine, public health education programmes should be promoted effectively and target specifically the groups who are most hesitant to receive the vaccine such as young people, females, and non-medical students. Vaccine hesitancy among healthcare workers can affect vaccination rates as the majority of the population views them as a trustworthy source for vaccine-related knowledge. Staff training is important to enhance their confidence and communication skills in providing information about COVID-19 vaccination to combat the misunderstanding of the public and encourage vaccine uptake.

PROSPERO REGISTRATION NUMBER

CRD42021248016.

Usage of social media and Covid 19 vaccine hesitancy among medical students in Kericho County

The recent Covid 19 pandemic revealed the global challenge posed by infectious diseases. Vaccines are a crucial tool in preventing pandemics, as evidenced by their success in controlling past outbreaks. The rise of information and communication technology has introduced social media platforms as potential game-changers in both preventing and managing future pandemics. However, these same platforms can also be a double-edged sword, hindering the uptake of essential vaccination services. This study investigated the association between social media use and vaccine hesitancy among medical students. The study was designed as an institution based cross sectional study of 423 medical students in Kenya Medical Training College and University of Kabianga in Kericho County. Stratified sampling was used to decide on the two institutions and systematic random sampling was used to select the study participants. Research administered questionnaires were used to collect data on the socio-demographic characteristics, use of social media platforms, social media campaigns, and uptake of Covid 19 vaccines. The collected data was analyzed using Statistical Package for Social Sciences version 25. Chi square was used to establish the association between the independent variables and uptake of Covid 19 vaccines. The variables that were significantly associated with hesitancy to Covid 19 vaccines were further analyzed using binary logistic regression. The confidence interval (CI) was set at 95% and statistical significance was considered at p < 0.05. The study found significant associations between vaccine hesitancy and several factors, including academic level, preferred social media platform, the influence of social media on attitudes towards vaccines, concerns about vaccine safety and efficacy, and confidence in vaccines. The findings present social media as a potential platform for promotion of vaccines utilization during pandemics when used well.

Knowledge, attitude, and practice of Egyptian medical students towards healthcare workers' recommended vaccines: a nationwide cross-sectional survey

BACKGROUND

Vaccination of healthcare workers (HCWs) is pivotal in decreasing the incidence of contagious infections in hospital settings. In this study, we assessed the knowledge, attitude, and practice regarding HCWs' recommended vaccines among medical students and interns in Egypt.

METHODS

A multicenter, cross-sectional study was conducted using a structured, pilot-tested, and self-administered questionnaire among Egyptian medical students and interns. We invited 1332 participants to our survey using a systematic random sampling that included participants across nine medical schools in Egypt during the 2021-2022 academic year.

RESULTS

Out of 1332 participants, 1141 completed our questionnaire with a response rate of 85.7%. Overall, 43% of the participants had intermediate knowledge (knew 2-3 HCWs' recommended vaccines). Furthermore, 36.7% had received a booster dose of at least one of the HCWs' recommended vaccines over the last 10 years, with only 6.1% having received all recommended vaccines. Hepatitis B vaccine was the most widely known (71%) and received (66.7%). Interns were more likely to know, receive, and recommend HCWs' recommended vaccines. The majority (> 90%) agreed that vaccination is beneficial and safe, with a median score of eight (interquartile range [IQR: Q25-Q75]: 7-9) out of ten for vaccine efficacy and eight (IQR: 7-8) for safety. However, the median score for hesitancy was five (IQR: 2-7). The most common influential and limiting factors for vaccination were scientific facts (60.1%) and fear of vaccine side effects (44.9%).

CONCLUSION

Although medical students in Egypt have good knowledge of and attitudes towards vaccination, there is a gap in their practices. Interventions are needed to improve vaccination uptake among medical students in Egypt.

Vaccine hesitancy among college students and individuals seeking healthcare: A social norms perspective

OBJECTIVE

Health behavior research suggests that perceived social norms impact health decisions. This study aimed to (a) examine reasons for vaccine hesitancy among a sample of college students compared to a clinical sample (b) examine the accuracy of perceptions of others' receptivity and intention to seek out the COVID-19 vaccine, and (c) determine whether greater self-other normative discrepancies (SODs) were associated with increased likelihood to seek out the COVID-19 vaccine.

PARTICIPANTS

Participants included 227 students at a Northeastern private college and 140 patients seeking medical care.

METHODS

College students completed an online, anonymous survey. Patients completed a paper-and-pencil survey distributed at appointment check-in.

RESULTS

Compared to their perceptions of others, participants had more positive beliefs about vaccines. The most common reason prompting individuals to seek out the vaccine was to return to "normal life."

CONCLUSIONS

Future research might examine use of social norms interventions to decrease vaccine hesitancy.

"There's a little bit of mistrust": Red River Métis experiences of the H1N1 and COVID-19 pandemics

We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.

Vaccine Equity: Lessons Learned Exploring Facilitators and Barriers to COVID-19 Vaccination in Urban Black Communities

COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.

Exploring the Inherent Heterogeneity of Vaccine Hesitancy: A Study of a Childhood-Vaccine-Hesitant Population

Vaccine hesitancy and its determinants have been previously widely researched. Vaccine hesitancy has been defined as a continuum of attitudes, ranging from accepting vaccines with doubts to rejecting them. The present study aims to explore the heterogeneity of a childhood-vaccine-hesitant group by using a person-oriented approach-latent profile analysis. A non-representative cross-sectional sample of vaccine-hesitant Slovenians (N = 421, Mage = 35.21, 82.9% women) was used to identify differences based on their reliance on personal research ("self" researching instead of relying on science), overconfidence in knowledge, endorsement of conspiracy theories, complementary and alternative medicine, and trust in the healthcare system. The analysis revealed three profiles of vaccine-hesitant individuals. The most hesitant profile-vaccine rejecting-expressed the greatest reliance on personal research, expressed the highest endorsement of conspiracy theories and complementary and alternative medicine, showed moderate overconfidence in their knowledge, and expressed the highest levels of distrust in the healthcare system. We further found differences in sociodemographic structure and that the identified profiles differed in their attitudes regarding MMR, HPV, and Seasonal Influenza vaccinations. The present study demonstrates the heterogeneity of the vaccine-hesitant community and offers insights into some of the traits, which are crucial for designing pro-vaccine campaigns.

Prevalence and Factors Affecting Willingness to Accept or Refuse Vaccination against COVID-19 among Healthcare Professionals in Southern Tunisia

BACKGROUND

The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. Health care professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. This study aimed to estimate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors. Methods: This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of HCP in Southern Tunisia, on March-April 2021. Results: Among 300 participants, the COVID-19 vaccine acceptability rate was 65.3%. Factors independently associated with vaccine acceptability were age groups <30 years [Adjusted Odds Ratio (AOR)=4.36; p = 0.002)], urbanity of residence (AOR = 3.44; p = 0.027), medical professional category (AOR = 2.69; p = 0.023) and caring for coronavirus infected patients (AOR = 2.32; p = 0.047). Belief that COVID-19 vaccination is important to work safely as a health care provider (AOR = 3.26; p = 0.013), should be available for all HCP (AOR = 17.98; p = 0.004) and has been quickly developed before it has been thoroughly vetted and tested for efficacy and safety (AOR = 5.88; p < 0.01) were independently associated with willingness to accept vaccine. Planning to get a COVID-19 vaccine for the next years and recommending it to the family were independent predictive factors of accepting COVID-19 vaccine ((AOR = 6.88; p < 0.001) and (AOR = 25.03; p < 0.001), respectively).Conclusion: The acceptance rate of vaccination against COVID-19 among Tunisian HCP is still low in South Tunisian hospitals. Socio-demographic, cultural and professional factors predisposing to the vaccination willingness were highlighted. Combating the vaccine hesitancy of HCP through enhancing sensibilization campaigns is essential to promote vaccination in general population.

Is resistance to Covid-19 vaccination a "problem"? A critical policy inquiry of vaccine mandates for healthcare workers

As the COVID-19 global vaccination campaign was launched in December of 2020, vaccination became mandatory for many healthcare workers (HCWs) worldwide. Large minorities resisted the policy, and the responses of authorities to this resistance led to damaged professional reputations, job losses, and suspension or termination of practice licenses. The joint effect of dismissals, early retirements, career changes, and vaccine injuries disabling some compliant HCWs from adequate performance has exacerbated existing crises within health systems. Nevertheless, leading health authorities have maintained that the benefits of a fully vaccinated healthcare labor force-believed to be protecting health systems, vulnerable patient populations, and even HCWs themselves-achieved through mandates, if necessary, outweigh its potential harms. Informed by critical policy and discourse traditions, we examine the expert literature on vaccine mandates for HCWs. We find that this literature neglects evidence that contradicts official claims about the safety and effectiveness of COVID-19 vaccines, dismisses the science supporting the contextual nature of microbial virulence, miscalculates patient and system-level harms of vaccination policies, and ignores or legitimizes the coercive elements built into their design. We discuss the implications of our findings for the sustainability of health systems, for patient care, and for the well-being of HCWs, and suggest directions for ethical clinical and policy practice.

Longitudinal trends in perceptions of COVID-19, vaccination, and barriers to COVID-19 vaccination among college students

OBJECTIVE

To assess changes in perceptions of COVID-19 worry and perceived severity, changes in COVID-19 vaccination status, and barriers to COVID-19 vaccination among college students.

PARTICIPANTS

2,252 participants were recruited from a personal wellness course across four academic semesters at a large public university.

METHODS

Participants completed an anonymous online survey. Changes between groups were analyzed to capture changing perceptions and behaviors related to COVID-19.

RESULTS

COVID-19 related worry, perceived severity, and vaccination against COVID-19 significantly decreased over time. However, flu vaccination status did not decrease. The top three cited reasons for vaccination hesitation were concerns about side effects, being healthy and young, and at low risk for getting infected.

CONCLUSION

Given the likely endemic nature of COVID-19, it is important for universities to continue to provide health education regarding transmission prevention, promote COVID-19 vaccination, and reduce myths regarding side-effects and risk perception.

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

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

Understanding Vaccine Hesitancy in U.S. Prisons: Perspectives from a Statewide Survey of Incarcerated People

Much of the American response to the COVID-19 pandemic was characterized by a divergence between general public opinion and public health policy. With little attention paid to individuals incarcerated during this time, there is limited direct evidence regarding how incarcerated people perceived efforts to mediate the harms of COVID-19. Prisons operate as a microcosm of society in many ways but they also face unique public health challenges. This study examines vaccine hesitancy-and acceptance-among a sample of individuals incarcerated within adult prisons in Pennsylvania. Using administrative records as well as rich attitudinal data from a survey of the incarcerated population, this study identifies a variety of social and historical factors that are-and are not-associated with an incarcerated person's willingness to receive the COVID-19 vaccine. Our findings highlight vaccination challenges unique to the carceral context and offer policy recommendations to improve trust in credible health messengers and health service provision for this often overlooked but vulnerable population.

Trusted sources of information on COVID-19 vaccine in Uganda

BACKGROUND

The COVID-19 pandemic has dramatically impacted communities worldwide, particularly in developing countries. To successfully control the pandemic, correct information and more than 80% vaccine coverage in a population were required. However, misinformation and disinformation could impact this, thus increasing COVID-19 vaccine hesitancy in communities. Several studies observed the effect of misinformation and disinformation on COVID-19 vaccine acceptance and other responses to the pandemic in the African continent. Thus, the most trusted sources of information on COVID-19 vaccines are critical for the successful management and control of the pandemic. This study aimed to assess the most trusted sources of information on COVID-19 vaccines during the pandemic in Uganda.

METHODS

We conducted a cross-sectional study on 587 adult population members in northern Uganda. Single-stage stratified and systematic sampling methods were used to select participants from northern Uganda. An interviewer-administered questionnaire with an internal validity of Cronbach's α = 0.72 was used for data collection. An Institution Review Board (IRB) approved this study and Stata version 18 was used for data analysis. A Pearson Chi-square (χ2) analysis was conducted to assess associations between trusted sources of COVID-19 vaccine information and selected independent variables. Fisher's exact test considered associations when the cell value following cross-tabulation was < 5. A P-value < 0.05 was used as evidence for an association between trusted sources of information and independent variables. All results were presented as frequencies, proportions, Chi-square or Fisher's exact tests, and P-values at 95% Confidence Intervals (CI).

RESULTS

In a study of 587 participants, most were males, 335(57.1%), in the age group of 25-34 years, 180(31.4%), and the most trusted source of COVID-19 vaccine information were the traditional media sources for example, Televisions, Radios, and Newspapers, 349(33.6%). There was no significant association between sex and trusted sources of COVID-19 vaccine information. However, by age-group population, COVID-19 vaccine information was significantly associated with internet use (14.7% versus 85.3%; p = 0.02), information from family members (9.4% versus 90.6%; p < 0.01), and the Government/Ministry of Health (37.9% versus 62.1%; p < 0.01). Between healthcare workers and non-health workers, it was significantly associated with internet use (32.2% versus 67.8%; p = 0.03), healthcare providers (32.5% versus 67.5%; p < 0.018), the Government/Ministry of Health (31.1% versus 68.9%; p < 0.01), and scientific articles (44.7% versus 55.3%; p < 0.01).

CONCLUSION

The most trusted sources of COVID-19 vaccine information in northern Uganda were Televisions, Radios, and Newspapers. The trusted sources of COVID-19 vaccine information were not significantly different between males and females. However, there were significant differences among age groups and occupations of participants with younger age groups (≤ 44 years) and non-healthcare workers having more trust in Televisions, Radios, and Newspapers. Thus, for effective management of an epidemic, there is a need for accurate communication so that misinformation, disinformation, and malinformation in the era of "infodemic" do not disrupt the flow of correct information to communities.

Medical and dental student knowledge about COVID-19 and influenza vaccines impact opinions about vaccine advocacy and future practice

Introduction

The World Health Organization has identified vaccine hesitancy as a global public health challenge. Healthcare providers are among the most influential and trusted figures for vaccine counseling. This article focuses on COVID-19 and influenza personal immunization behaviors, vaccine knowledge and opinions, and vaccine counseling confidence among future healthcare providers - dental and medical students.

Methods

A cross-sectional anonymous online survey was conducted at four dental schools and one allopathic medical school in the United States. Items included personal vaccination status for the COVID-19 and influenza vaccines and vaccine-specific items developed based on past research to assess knowledge, opinions, and behaviors.

Results

Two hundred and thirty-two medical and 221 dental students completed the survey. 68 and 55% scored average/above-average knowledge on COVID-19 and influenza vaccine items, respectively. There were significant differences between those with average/above-average and below-average knowledge scores regarding learning about, recommending, and advocating for vaccines and counseling vaccine-hesitant patients for both vaccines (p < 0.0001). Although higher-knowledge students had higher vaccination rates (p < 0.0001), many had insufficient knowledge about vaccines.

Discussion

Healthcare providers play a crucial role in vaccine advocacy. The identified knowledge gaps are significant as they impact quality of patient care. And opinions about future vaccination practice such as recommending, providing, and counseling about vaccines. Equipping students with knowledge and communication skills will enable them to be strong vaccine advocates to improve overall public health.

Hesitancy Towards COVID-19 Vaccine Among Students of Medical and Allied Health Sciences in Khyber Pakhtunkhwa

Objective

To measure COVID-19 vaccine hesitancy and its associated factors among medical and allied health sciences students of Khyber Pakhtunkhwa.

Methodology

This cross-sectional survey was conducted online using Google survey platform in March 2021. Study population comprised of medical and allied health sciences students studying in medical/allied health sciences academic institutes in Khyber Pakhtunkhwa. The web-based online link was provided to around 800 students to fill in the questionnaire via email, WhatsApp and/or social media network. Response rate was around 50%. The main outcome variable was vaccine hesitancy. Factors associated with vaccine hesitancy were explored by bivariate and multivariate regression analysis.

Results

Out of 398 medical and allied health sciences students, there were 193 (48.5%) males and 205 (51.5%) females with mean age was 22.6± 2.8 years. The vaccine hesitancy rate was found to be 52.8%. A significant relationship between vaccine hesitancy and gender was observed. Other factors including lack of adequate knowledge about vaccines (p < 0.001), Chinese origin of vaccines (p < 0.001), lack of knowledge that vaccination can reduce the chances of acquiring infection (p < 0.001), fear of potential side effects (p < 0.001) and hidden agenda behind free forceful vaccination (p = 0.045), were found to be main barriers or reasons responsible for COVID-19 vaccine hesitancy among medical and allied health sciences students.

Conclusion

Important associated barriers with COVID-19 vaccine hesitancy included gender, lack of information, fear of side effects, lack of trust in imported and Chinese vaccines, and perception of hidden agenda behind COVID-19 vaccination.

Assessment of Covid-19 vaccine confidence among healthcare personnel in the safety-net sector in the United States and Puerto Rico

BACKGROUND

This study aimed to assess COVID-19 vaccine confidence among healthcare personnel in the safety net sector of the United States and Puerto Rico. This study aimed to examine the extent to which increased knowledge and positive attitudes toward COVID-19 vaccine safety and efficacy were associated with healthcare workers' COVID-19 vaccination status and their recommendation of the vaccine to all patients.

METHODS

Online survey data were collected from health care workers working in Free and Charitable Clinics across the United States and Federally Qualified Health Centers in Puerto Rico. The survey consisted of 62 questions covering various demographic measures and constructs related to healthcare workers' vaccination status, beliefs, and recommendations for COVID-19 vaccination. Statistical analyses, including multivariate analysis, were conducted to identify the factors associated with the COVID-19 vaccine status and recommendations among healthcare personnel.

RESULTS

Among the 2273 respondents, 93% reported being vaccinated against COVID-19. The analysis revealed that respondents who believed that COVID-19 vaccines were efficacious and safe were three times more likely to be vaccinated and twice as likely to recommend them to all their patients. Respondents who believed they had received adequate information about COVID-19 vaccination were 10 times more likely to be vaccinated and four times more likely to recommend it to all their patients.

CONCLUSIONS

The study results indicate that healthcare workers' confidence in COVID-19 vaccines is closely tied to their level of knowledge, positive beliefs, and attitudes about vaccine safety and efficacy. The study emphasizes the significance of healthcare workers feeling well informed and confident in their knowledge to recommend the vaccine to their patients. These findings have important implications for the development of strategies to boost COVID-19 vaccine confidence among healthcare workers and increase vaccine uptake among patients.

Cross-Country Discrepancies in Monkeypox Vaccine Hesitancy Among Postgraduate and Undergraduate Medical Students

BACKGROUND

Medical students hold significant importance, as they represent the future of healthcare provision. This study aimed to explore psychological antecedents towards the monkeypox (mpox) vaccines among postgraduate and undergraduate medical students across countries.

METHODS

A cross-sectional survey was conducted among medical students aged 18 years old and above in 7 countries; Egypt, Romania, Malaysia, and Yemen, Iraq, India, and Nigeria. We used social media platforms between September 27 and November 4, 2022. An anonymous online survey using the 5C scale was conducted using snowball and convenience Sampling methods to assess the 5 psychological antecedents of vaccination (i.e., confidence, constraints, complacency, and calculation, as well as collective responsibility).

RESULTS

A total of 2780 participants were recruited. Participants' median age was 22 years and 52.1% of them were males. The 5C psychological antecedents of vaccination were as follows: 55% were confident about vaccination, 10% were complacent, 12% experienced constraints, and 41% calculated the risk and benefit. Lastly, 32% were willing to be vaccinated for the prevention of infection transmission to others. The Country was a significant predictor of confidence, complacency, having constraints, and calculation domains (P < 0.001). Having any idea about the mpox vaccine was linked to 1.6 times higher odds of being more confident [OR = 1.58 (95% CI, 1.26-1.98), P < 0.001] Additionally, living in a rural area significantly increased complacency [OR = 1.42 (95% CI, 1.05-1.95), P = 0.024] as well as having anyone die from mpox [OR = 3.3 (95% CI, 1.64-6.68), P < 0.001]. Education level was associated with increased calculation [OR = 2.74 (95% CI, 1.62-4.64), P < 0.001]. Moreover, being single and having no chronic diseases significantly increased the calculation domain [OR = 1.40 (95% CI, 1.06-1.98), P = 0.02] and [OR = 1.54 (95% CI, 1.10-2.16), P = 0.012] respectively. Predictors of collective responsibility were age 31-45 years [OR = 2.89 (95% CI, 1.29-6.48), P = 0.01], being single [OR = 2.76 (95% CI, 1.94 -3.92), P < 0.001], being a graduate [OR = 1.59 (95% CI (1.32-1.92), P < 0.001], having no chronic disease [OR = 2.14 (95% CI, 1.56-2.93), P < 0.001], and not knowing anyone who died from mpox [OR = 2.54 (95% CI, 1.39-4.64), P < 0.001), as well as living in a middle-income country [OR = 0.623, (95% CI, 0.51-0.73), P < 0.001].

CONCLUSIONS

This study underscores the multifaceted nature of psychological antecedents of vaccination, emphasizing the impact of socio-demographic factors, geographic location, and awareness, as well as previous experiences on individual attitudes and collective responsibility towards vaccination.

Understanding facilitators and barriers to COVID-19 vaccination in the Zimbabwean population: a qualitative analysis

BACKGROUND

Vaccines are effective biological interventions that reduce health burdens. However, during the COVID-19 pandemic, there were concerns about varying levels of COVID-19 vaccination coverage in the Zimbabwean population. This study aimed to understand facilitators and barriers to COVID-19 vaccine uptake in the Zimbabwean population.

METHODS

In September-October 2023, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with a sample comprising health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected across the country. At each site, the participant sample was homogeneous. Data were collected using audiotapes, transcribed verbatim, and translated into English. Data were analysed manually using thematic analysis.

RESULTS

Ten FGDs and 30 KIIs were conducted across the country. Among the facilitators of COVID-19 vaccine uptake were the perceived benefits of COVID-19 vaccination, such as protection from infection, severe disease and death. People also complied with COVID-19 vaccination because of the government's call for mandatory vaccination, travel restrictions, restrictions when entering some premises for services, visiting, working, learning and functions. Barriers to COVID-19 vaccine uptake included low-risk perception, negative attitudes emanating from concerns about the origins of the vaccines, COVID-19 cases or death of vaccinated people, negative peer influence, religious doctrines, cultural beliefs and misconceptions circulating through social media. Other barriers included knowledge gaps on COVID-19 vaccines, safety, effectiveness, side effects, access-related challenges to COVID-19 services and concerns over the changing policy on COVID-19 vaccination.

CONCLUSIONS

The study has shown the importance of community engagement and data-driven public health communication strategies to facilitate behaviour change for increased uptake of a vaccine. In future epidemics, public health campaigns should focus on the timely provision of information explaining the benefits of an intervention, addressing safety concerns more effectively. To build trust and hence improve vaccine uptake by the public, there is a need for continuous engagement with people and to provide platforms for dialogue to address issues contributing to low vaccine uptake.

Do Not Throw Away Your Shot: Pilot Study in Improving Medical School Curricula Through Focused Vaccine Education

Introduction

With widely prevalent vaccine hesitancy and medical mistrust, future healthcare providers require knowledge of vaccines and comfort in discussing vaccines with patients. However, many U.S. medical schools do not offer formal or elective curricula focused on vaccine education.

Methods

We sought to identify the need for such a curriculum and student gaps in knowledge through a pilot study surveying first- and second-year medical students at a large Pennsylvania medical school to assess knowledge about vaccine initiatives/policies, comfort in discussing vaccines, attitudes toward curricular changes, and effects of COVID-19 on willingness for vaccine education.

Results

Many participants (>40%) reported insufficient knowledge of vaccine policy, vaccine development and testing, and community vaccine initiatives. The majority (>50%) indicated discomfort in discussing vaccines in a clinical setting. Importantly, 79% of participants reported insufficient coverage of vaccine topics in the current curriculum. A total of 54% decisively wanted formal/mandatory education versus 72% who decisively wanted elective education. Desiring formal education was associated with less comfort in discussing vaccines overall and with vaccine-hesitant people in clinical settings. Reassuringly, 74% of participants noted that the COVID-19 pandemic made them want to learn more about vaccines. Guided by these findings, we conducted a pilot elective teaching about vaccines through case studies, interactive discussions, and role-playing scenarios. Pre- and postcourse surveys showed improvement in student knowledge in all vaccine-related topics assessed.

Conclusions

These data can inform the development of formal and elective curricula that effectively prepare medical students for patients' vaccine questions.

Frequency of vaccine hesitancy among patients with advanced cancer

BACKGROUND

Vaccine hesitancy has become prevalent in society. Vulnerable populations, such as those with cancer, are susceptible to increased morbidity and mortality from diseases that may have been prevented through vaccination.

OBJECTIVES

Our objective was to determine patient perception of vaccine efficacy and safety and sources of information that influence decisions.

METHODS

This study was a prospective cross-sectional survey trial conducted from March 10, 2022, to November 1, 2022, at a Supportive Care Clinic. Patients completed the survey with a research assistant or from a survey link. Vaccine hesitancy was defined as a response of 2 or more on the Parent Attitudes About Childhood Vaccines (PACV-4). Perception on vaccine safety and efficacy along with the importance of sources of information were determined by a questionnaire.

RESULTS

Of the 72 patients who completed the PACV-4, 30 were considered vaccine-hesitant (42%). Of those who completed the survey alone (35), 23 (66%) were vaccine-hesitant; and of those who completed the survey with the help of a study coordinator (37), 7 (19%) were vaccine-hesitant. The most important source for decision-making was their doctor (82%, 95% CI 73-89), followed by family (42%, 95% CI 32-52), news/media (31%, 95% CI 22-41), and social media (9%, 95% CI 4-16). Clinical and demographic factors including age, gender, race/ethnicity, education level, and location of residence were not associated with vaccine hesitancy.

SIGNIFICANCE OF RESULTS

Vaccine hesitancy is present among patients with advanced cancer. The high value given to the doctor's recommendation suggests that universal precautions regarding vaccine recommendation may be an effective intervention.

COVID-19 vaccines breakthrough infection and adverse reactions in medical students: a nationwide survey in Iran

Introduction

There are different types of COVID-19 vaccines approved worldwide. Since no national studies focus on vaccine-related adverse reactions and breakthrough cases, this study aimed to investigate the rate of adverse events and COVID-19 infection in medical students in Iran.

Methods

This retrospective cohort study included Iranian medical students who received two doses of COVID-19 vaccines. The medical team gathered the demographic characteristics, comorbidities, type of vaccine, adverse events following vaccination, and history of COVID-19 infection data through a phone interview. The frequency of adverse events and breakthrough infection was stratified by vaccine type (ChAdOx1-S, Gam-COVID-Vac, and BIBP-CorV).

Results

A total of 3,591 medical students enrolled in this study, of which 57.02% were females, with a mean age of 23.31 + 4.87. A PCR-confirmed and suspicious-for-COVID-19 breakthrough infection rate of 4.51 and 7.02% was detected, respectively. There was no significant relation between breakthrough infection and gender, BMI, blood groups, and comorbidities. However, there was a significant difference in breakthrough infection rate among different types of vaccines (p = 0.001) and history of COVID-19 infection (p = 0.001). A total of 16 participants were hospitalized due to COVID-19 infection after vaccination for reasons such as dyspnea, abnormal imaging, or decreased oxygen saturation. No severe infection or death was observed in the studied population.

Conclusion

Vaccination prevented severe COVID-19 infection, although a high breakthrough infection rate was evident among Iranian medical students during the Delta variant's peak. Vaccine effectiveness may be fragile during emerging new variants and in high-exposure settings. Moreover, adverse events are rare, and the benefits of vaccination outweigh the side effects. However, many limitations challenged this study, and the results should be cautious.

Otolaryngologic Side Effects After COVID-19 Vaccination

OBJECTIVES

With widespread vaccination against COVID-19, concerns regarding side effects have been raised. We aim to assess the frequency of otolaryngologic adverse events (AEs) following COVID-19 vaccination as compared with other vaccines in a national database.

STUDY DESIGN

Retrospective analysis of national registry.

METHODS

The Food and Drug Administration's Vaccine Adverse Event Reporting System (VAERS) database was queried from December 2020 to May 2021 for all COVID-19 vaccination AEs. Complaints were categorized as otolaryngologic and sub stratified into different anatomic components. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were determined for AEs of clinical significance.

RESULTS

The total number of AEs reported from vaccination with the Moderna, Pfizer-BioNTech, and Janssen vaccines equaled 1,280,950. Of these, 62,660 (4.9%) were otolaryngologic in nature, with 32.6% associated with the oropharynx/larynx, 18.3% with the nasal cavity/sinuses, 17.1% with the ears/vestibular system, 10.0% with the oral cavity, and 21.9% miscellaneous. Signal ratios reached significance levels for dysgeusia (n = 2124, PRR: 17.33, ROR: 16.36), ageusia (n = 1376, PRR: 2.81, ROR: 2.81), anosmia (n = 983, PRR: 4.01, ROR: 4.01), rhinorrhea (n = 2203, PRR: 2.99, ROR: 3.00), throat tightness (n = 3666, PRR: 4.99, ROR: 5.00), throat irritation (n = 3313, PRR: 4.51, ROR: 4.52), dysphagia (n = 2538, PRR: 2.07, ROR: 2.07), tinnitus (n = 4377, PRR: 3.97, ROR: 3.98), and vertigo (n = 2887, PRR: 3.93, ROR: 3.93). Signal ratios were not significant for facial paralysis, Bell's palsy, anaphylaxis, sinusitis, hearing disability, and ear pain.

CONCLUSIONS

Although several otolaryngologic symptoms were reported, few were found to be clinically significant. Of note, facial paralysis, Bell's palsy, and anaphylaxis did not meet signal thresholds to be determined significant.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:1163-1168, 2024.

Surname order and revaccination intentions during the COVID-19 pandemic

Teachers in Japanese schools employ alphabetical surname lists that call students sooner, with surnames appearing early on these lists. We conducted Internet surveys nearly every month from March 2020 to September 2022 with the same participants, wherein we asked participants where the alphabetical columns of their childhood and adult surnames were located. We aimed to identify how surname order is important for the formation of noncognitive skills. During the data collection period, the COVID-19 vaccines became available; Japanese people could receive their third dose starting in December 2021. The 19th wave of the survey was conducted in January 2022. Therefore, to examine how a surname's alphabetical order could influence intention to revaccinate, we used a subsample of data from December 2021 to September 2022. The major findings were as follows. Women with early surnames had an approximately 4% stronger likelihood of having such intentions than men with early surnames. Early name order was more strongly correlated with revaccination intention among women than among men. The surname effect for women was larger when a mixed-gender list was used compared with when it was not used. This effect was only observed for childhood surnames and not for adult surnames.

Cognizance and mitigation of falsified immunization documentation: Analyzing the consequences for public health in Nigeria, with a focus on counterfeited COVID-19 vaccination cards: A case report

Background and Aims

The global immunization campaign against COVID-19 has mandated vaccination certificates, leading to a surge in fake documentation. In Nigeria, the proliferation of counterfeit COVID-19 vaccination cards, facilitated by unscrupulous health workers, raises critical public health concerns. This research spotlights various forms of this malpractice, analyzes the factors contributing to the circulation of fake vaccination cards, their implications on public health, and provides recommendations for addressing the issue.

Methods

Extensive literature review and analysis were conducted to investigate the emergence of fake COVID-19 vaccination cards in Nigeria. Perspectives from health workers and reports from reputable undercover investigations were examined to identify factors contributing to the circulation of fraudulent records. The research also delved into corruption within the health sector and the impact of low salaries on healthcare workers. Additionally, global instances of fake vaccination cards were explored to provide a comprehensive understanding of the issue.

Results

Healthcare workers' vaccine hesitancy, corruption, and inadequate salaries were identified as key contributors to the circulation of fake vaccination cards in Nigeria. Instances of health workers accepting bribes to issue cards without administering vaccines were uncovered. The implications on public health included threats to herd immunity, compromised disease surveillance, erosion of public trust, and reinforcement of vaccine hesitancy. The research also highlighted global challenges with fake vaccination cards, emphasizing the need for international cooperation.

Conclusion

Fake vaccination cards in Nigeria poses challenges to public health, affecting the reliability of immunization data and jeopardizing disease control efforts. It is crucial to strengthen healthcare worker engagement, tackle corruption through increased transparency and improved policies, and implement digital vaccination verification systems. International collaboration is essential to establish standardized security measures and verification checkpoints. Addressing flawed vaccination records requires urgent action to enhance vaccination efforts, and safeguard the population from the resurgence of vaccine-preventable diseases.

Bridging the Gaps: The Transformative Effect of Coronavirus Disease 2019 (COVID-19) on Preventive Measures Among Medical and Health Sciences College Students in Madinah, Saudi Arabia

Background The global impact of coronavirus disease 2019 (COVID-19) has disrupted the activities of medical and health profession education institutions. This study aimed to determine the impact of COVID-19 on medical and health profession education students' knowledge, attitudes, and practices toward preventive measures and their commitment to precautionary measures before, during, and after the pandemic. Materials and methods A cross-sectional study was carried out from January to March 2023 using an online, structured, validated questionnaire survey to gather information from medical and health sciences students from three universities, encompassing five colleges in Madinah, Saudi Arabia. The minimum required sample size was estimated using the Epi Info software as 380. The data was analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Statistical tests including Student's t-test, chi-squared test, and analysis of variance (ANOVA) test were applied. Results The findings revealed that personal experiences with COVID-19 infection had a significant impact on students' attitudes and commitment to preventive measures (p<0.05). Among the participants, 172 students (45%) reported having contracted COVID-19. Students with clinical exposure showed a higher level of understanding and adherence to preventive measures (248 students, 68%), compared to pre-clinical students (198 students, 52%) (p<0.05). Positive attitudes were observed toward practices such as sneezing etiquette (289 students, 76%) and flu vaccination (314 students, 83%) (p<0.05). However, negative attitudes were observed toward mask-wearing (155 students, 41%) and social distancing (144 students, 38%), particularly among male students (p<0.05). Conclusion The study provided valuable insights into the impact of the COVID-19 pandemic on medical and health sciences students' knowledge, attitudes, and practices toward preventive measures and the importance of introducing COVID-19 prevention measures in the pre-clinical phase as well as mental health support to promote positive attitudes and enhance adherence to preventive measures.

Perceived experts are prevalent and influential within an antivaccine community on Twitter

Perceived experts (i.e. medical professionals and biomedical scientists) are trusted sources of medical information who are especially effective at encouraging vaccine uptake. The role of perceived experts acting as potential antivaccine influencers has not been characterized systematically. We describe the prevalence and importance of antivaccine perceived experts by constructing a coengagement network of 7,720 accounts based on a Twitter data set containing over 4.2 million posts from April 2021. The coengagement network primarily broke into two large communities that differed in their stance toward COVID-19 vaccines, and misinformation was predominantly shared by the antivaccine community. Perceived experts had a sizable presence across the coengagement network, including within the antivaccine community where they were 9.8% of individual, English-language users. Perceived experts within the antivaccine community shared low-quality (misinformation) sources at similar rates and academic sources at higher rates compared to perceived nonexperts in that community. Perceived experts occupied important network positions as central antivaccine users and bridges between the antivaccine and provaccine communities. Using propensity score matching, we found that perceived expertise brought an influence boost, as perceived experts were significantly more likely to receive likes and retweets in both the antivaccine and provaccine communities. There was no significant difference in the magnitude of the influence boost for perceived experts between the two communities. Social media platforms, scientific communications, and biomedical organizations may focus on more systemic interventions to reduce the impact of perceived experts in spreading antivaccine misinformation.

Side Effects Reported by Moroccan Medical Students Who Received COVID-19 Vaccines

BACKGROUND

Low confidence in the safety of COVID-19 vaccines was found to be a key promoter of vaccine reluctance especially among youth. Furthermore, young adults are an important demographic for building herd immunity through vaccination. As a result, their reactions to getting COVID-19 vaccines are crucial in our fight against SARS-CoV-2.

OBJECTIVE

The overall goal of this study was to look into the shortterm side effects experienced by Moroccan medical and pharmacy students after receiving COVID-19 vaccines.

METHODS

A cross-sectional survey-based study to assess the COVID-19 vaccines' short-term AEFIs among Moroccan medical and pharmacy students. The validated questionnaire was delivered in a digital form to explore the side effects (SE) they encountered after the first or the second dose of one of three vaccines namely: AstraZeneca Vaxzevria, PfizerBioNTeck, and SinoPharm vaccines.

RESULTS

There were 510 students in total who took part. After the first and second doses, approximately 72 percent and 78 percent of subjects, respectively, reported no SE. The remainder had localized injection site side effects (26%). Fatigue (21%), fever (19%), headache (17%), and myalgia (16%) were the most common systemic adverse effects after the first dose. There were no serious SEs reported.

CONCLUSION

The majority of the reported AEFIs in our data were mild to moderate in intensity and lasted only one or two days. COVID-19 vaccinations are highly likely safe for young adults, according to the findings of this study.

The Role of Information Visualisation and Anecdotal Evidence in Medical Students' Clinical Reasoning Process: A Cross-Sectional Survey Study

BACKGROUND

Medical students are often taught clinical reasoning implicitly, rather than through a formal curriculum. Like qualified health professionals, they engage in a wide range of information seeking and other practices as part of the clinical reasoning process. This increasingly includes seeking out information online and being informed by anecdotal information from social media or peer groups. The aim of this research was to investigate how anecdotes and icon arrays influenced the clinical reasoning process of medical students deciding to prescribe a hypothetical new drug.

METHODS

A cross-sectional survey design was used. The survey required participants to respond to six hypothetical clinical scenarios in which they were asked to prescribe a hypothetical drug "polypill" for a specific patient. The order of delivery of the six scenarios was randomised for each participant. In response to each scenario, participants indicated how effective they perceived each drug to be. The study received ethics approval from the University of Sydney Human Research Ethics Committee: Protocol No: 2019/001. All participants provided written informed consent before agreeing to participate in the study.

RESULTS

A total of 56 medical students fully completed the survey. Statistical analysis of the responses indicated that the icon array may be effective for highlighting how the polypill reduces CVD risk, reducing the impact of anecdotes on efficacy judgments. Without the icon array, both the positive and negative anecdotes made participants less willing to prescribe the polypill.

CONCLUSIONS

Medical student clinical reasoning processes appear to be influenced by anecdotal information and data visualisations. The extent of this influence is unclear, but there may be a need to actively educate students about the influence of these factors on their decision-making as they graduate into a world where they will be increasingly interacting with anecdotal information on social media and visualisations of electronic data.

Vaccine Hesitancy in Israel: Exploring the Relationships with Vaccination History, Knowledge, and Attitudes towards Influenza Vaccines

Influenza vaccination is a highly effective strategy for mitigating all the repercussions of influenza infections. Despite the potential severity of influenza and the accessibility of secure vaccinations, worldwide rates of influenza vaccination continue to be low, particularly among students. This study examines the correlative relationships between influenza vaccine history, knowledge, attitudes toward influenza vaccines, and vaccine hesitancy among college students. To that end, we used an online questionnaire to conduct a cross-sectional study encompassing 610 students. A significant majority of participants reported having experienced influenza (82%), with slightly more than half having received influenza vaccinations in the past (57%). With respect to the current research year, health sciences students exhibited a higher likelihood of either having been vaccinated or intending to receive the vaccine than did their counterparts. Among students who had been vaccinated previously, approximately one-fifth opted for vaccination in the present year (21%). Similarly, 22% of the students whose parents were vaccinated chose to get vaccinated this year. Notable disparities in knowledge about influenza vaccines were observed across various departments, with health sciences students demonstrating the highest levels of awareness. Moreover, a negative relationship was found between knowledge, attitudes, and vaccine hesitancy. These results suggest that targeted lectures by professionals emphasizing vaccine safety and university-hosted events addressing this subject in collaboration with the Ministry of Health, incorporating influenza vaccination stations, could be instrumental in bolstering the vaccination rate.

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

Clinical characteristics of motor functional neurological disorder manifesting as limb weakness after vaccination against coronavirus disease 2019: A case series

Background

The characteristics of functional limb weakness (FLW) as one of the manifestations of functional neurological disorder after vaccination against coronavirus disease 2019 (COVID-19) remain controversial.

Methods

In this descriptive case series, we aimed to elucidate the characteristics of Japanese patients with FLW who claimed muscle weakness after COVID-19 vaccination among patients who visited our outpatient clinic between 1 June 2021 and 31 December 2022.

Results

Nine patients were diagnosed with FLW (mean age: 30.8 years), including two men and seven women. Seven patients were vaccinated with the BioNTech/Pfizer vaccine and two with the mRNA-1273 Moderna vaccine. All patients demonstrated various positive signs for FLW. Magnetic resonance imaging or computed tomography indicated no abnormality that could explain their symptoms. At the time of the clinic visit, five patients were treated for psychiatric disorders, including depression, insomnia, attention-deficit hyperactivity disorder, and Asperger's syndrome. Muscle weakness spread to the limbs beyond the vaccinated arm in seven patients.

Conclusions

We describe the basic characteristics of FLW in Japanese patients after COVID-19 vaccination. Further recognition of these characteristics could aid the diagnosis of FLW by physicians allowing them to support these patients effectively.

Factors Associated with COVID-19 Vaccine Uptake Among High School Students in a Large, Diverse Metropolitan Area

BACKGROUND

Because previous studies on adolescent COVID-19 attitudes focused on intent to get vaccinated, this study examined attitudinal factors and racial/ethnic differences associated with vaccine uptake.

METHODS

In a cross-sectional survey of a metropolitan high school district, students were asked about their COVID-19 attitudes, information sources, and whether they had been vaccinated. Logistic regression predicted vaccination status and adjusted odds ratios (aOR) controlled for race/ethnicity.

RESULTS

Being unvaccinated was associated with themes of distrust with concerns about vaccine newness (aOR: 0.10; 95% confidence intervals [CI]: 0.06-0.15), side effects (aOR: 0.22; 95% CI: 0.15-0.33), efficacy (aOR: 0.25; 95% CI: 0.17-0.38), distrust of vaccines (aOR: 0.16; 95% CI: 0.09-0.27), government oversight (aOR: 0.19; 95% CI: 0.13-0.30), and politicization (aOR: 0.60; 95% CI: 0.41-0.88). Vaccine uptake was influenced by official information sources, school closures, and vaccine availability. The majority of vaccinated and unvaccinated students trusted primary care professionals as a source for COVID-19 information, but their influence varied across race/ethnic groups.

CONCLUSIONS

Trust and distrust were the main themes of vaccinated and unvaccinated students, respectively. Incorporating trusted information sources (primary care professionals) in information dissemination efforts may improve vaccine uptake.

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Novel COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students: a scoping review

Medical students are likely to be exposed to COVID-19 patients so achieving high vaccination coverage rates for this group of healthcare workers is important, as is their potential as vaccination role models. The aim of this scoping review was to evaluate the current literature to determine the rates of COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students. Systematic searches of the Medline Ovid, Embase, PubMed, and Education Resources Information Centre (ERIC) online databases was conducted for relevant articles with keywords: 'COVID-19', 'vaccine hesitancy & acceptance' and 'medical students'. Articles were included for review if they reported the rates of vaccine hesitancy and acceptance, and associated factors, amongst medical students. Of the 258 articles identified, 52 met the inclusion criteria and underwent full-text review. Rates of vaccine hesitancy ranged from 5.4-86.7%, with generally positive attitudes towards COVID-19 vaccination. The main factors associated with vaccine hesitancy were concerns about the safety and efficacy of vaccines due to their accelerated development, being a pre-clinical medical student, and low perceived personal risk of COVID-19 infection. Inconsistencies were found for the influence of gender on attitudes towards vaccinations. Previous vaccination behaviours were predictive of willingness to receive the COVID-19 vaccine. Knowledge about COVID-19 vaccinations and their importance was found to be deficient amongst vaccine hesitant medical students. Generally, medical students express low levels of vaccine hesitancy. However, due to the variability in the factors associated with vaccine hesitancy across different populations and the dynamic and contextual nature of hesitancy, it is recommended that vaccination intent and associated attitudes are monitored on a longitudinal basis. It is important to map vaccine hesitancy at a local level to allow medical schools to develop strategies to encourage vaccination specific to their school's needs.

University students' willingness to receive a COVID-19 vaccine in the United States

The disproportionate number of COVID-19 cases and deaths in the United States (US) requires understanding of health behaviors that contributed to low acceptance of public health guidelines. University students were at low risk for complications from COVID-19 infections but at high-risk for infecting others. It is important to understand which characteristics influenced willingness to receive the COVID-19 vaccine. The purpose of this cross-sectional study was to explore the social factors and identities that predicted university students' willingness to receive COVID-19 vaccines before one was available. This study used a stratified random sample from a Midwestern public university in 2020 (N = 614). Results suggest hesitancy toward childhood vaccinations, noncompliance with mask-wearing and large-group-avoidance guidelines, and conservative political ideology increased the odds of being unwilling to receive a COVID-19 vaccination. However, higher subjective social status and male gender increased the odds of being willing to be vaccinated.

Impact of sex and age on vaccine-related side effects and their progression after booster mRNA COVID-19 vaccine

In mRNA COVID-19 vaccination, side effects after the first and second dose have been well reported. However, studies about side effects after booster vaccine are sparse. 272 healthcare workers who received the third mRNA COVID-19 vaccine were recruited, and impact of sex, age, and symptoms on the side effect progression was statistically analyzed. Females and younger adults had a higher frequencies of general fatigue, headache, joint pain, chills and axillary pain compared to males and elderly adults, respectively. In longitudinal analysis, prolonged time to recovery from side effects was found among females and younger adults. Finally, between the third and second dose vaccinations, 52% of subjects had a longer duration of side effects following the third vaccine compared to the second, and joint pain was the culprit symptom related to the prolonged duration of side effects. Following the second vaccine dose, 25% of subjects had a longer duration of side effects and asthma and ear fullness, which exacerbated the underlying allergic condition, and COVID arm symptom were the culprit symptoms. These highlight the impact of sex, age, and culprit symptoms on the progress of side effects following the booster mRNA COVID-19 vaccine.

Path analysis of COVID-19 vaccine adherence among adolescents across Indonesia, in the Maluku-Papua Islands (Eastern Indonesia), and on Java Island

BACKGROUND

COVID-19 incidence in Indonesia was high among adolescents, but vaccine acceptance remains low. The unequal geographical distribution of the health workforce and health facilities in Indonesia, including a lower number of health workers and facilities in Maluku-Papua, resulted in a low rate of vaccine acceptance. Knowledge, attitude, belief in the vaccine, comorbidity, congenital status are related to vaccine adherence, but mediation analysis of factors remains lacking. We aimed to analyze path analysis of knowledge, congenital, comorbidity, belief, and attitude to COVID-19 vaccine adherence among adolescents in Indonesia, Maluku-Papua Island, and Java Island.

METHOD

A nationwide cross-sectional study was undertaken among 7604 adolescents. A path analysis to investigate mediating effects between variables combined with bootstrapping was utilized to determine statistical significance.

RESULT

Knowledge, congenital status, comorbidity, belief, and attitude were significantly positively associated with COVID-19 vaccine adherence among adolescents in Maluku-Papua Island (p < 0.01; n = 4761), Java Island (p < 0.01; n = 1573), and Indonesia (p < 0.05; n = 7604). Congenital status, belief, and attitude negatively mediated the relationship between knowledge of and adherence to COVID-19 vaccine (p < 0.01) in Indonesia and among the subgroup on Maluku-Papua Island (p < 0.01), but a positive mediation (p = 0.04) in our subgroup analysis of Java Island. Comorbidity status, belief, and attitude negatively mediated relationship between knowledge and adherence to COVID-19 vaccine in Indonesia (p ≤0.01) and Maluku-Papua (p = 0.00), but no mediation role was found in Java Island (p = 0.58).

CONCLUSION

Comorbidity, congenital illness status, belief in and attitude to COVID-19 vaccine negatively mediated the relationship between knowledge of and adherence to COVID-19 vaccine among adolescents in Indonesia and our sub-group on Maluku-Papua Island but not on Java Island.

PRACTICAL IMPLICATION

Massive improvement in healthcare facility equality plays an important role in Indonesia gaining COVID-19 vaccine adherence.

Unpacking COVID-19 Vaccine Attitudes: Exploring Hesitancy and Acceptance Among Undergraduate Students in Bangladesh

BACKGROUND

Vaccine hesitancy is a significant global health concern, and mass vaccination is essential in preventing the spread of COVID-19. Undergraduate students need to be prioritized for vaccination as they continue their academic curriculum physically. However, limited research explores vaccine hesitancy and acceptance among undergraduate students in Bangladesh. Therefore, this study evaluated vaccine hesitancy and acceptance among this population.

METHOD

A web-based cross-sectional study was conducted between May and June 2021 using a structured questionnaire to assess COVID-19 vaccine hesitancy and acceptance among undergraduate students in Bangladesh. The Oxford Covid-19 Vaccine Hesitancy Scale was used to measure vaccine hesitancy. The study used convenient sampling.

RESULT

Across the country, 334 undergraduate students participated in this study on COVID-19 vaccine acceptance, with a mean age of 22.4 years. Most participants were male and unmarried, most having spent four years at university. 89.52% of participants would accept a COVID-19 vaccine if it were suggested by educational institutions or available, while 4.49% refused to receive the COVID-19 vaccine. Participants showed low levels of vaccine hesitancy, with a mean score of 10.77 on the Oxford COVID-19 Vaccine Hesitancy Scale. Most participants had a positive attitude towards receiving the vaccine, with the majority wanting to get it as soon as it becomes available. No association was found between vaccine acceptance and participants' background characteristics.

CONCLUSION

Our study found a high level of vaccine acceptance among undergraduate students in Bangladesh, indicating that this group can be vaccinated quickly, significantly accelerating vaccination goals. However, further large-scale studies are recommended among vulnerable groups, including school and college students, to ensure vaccine preparedness.