Dispositional pandemic worry and the health belief model: promoting vaccination during pandemic events

Predicting College Students’ Preventative Behavior During a Pandemic: The Role of the Health Belief Model, Source Credibility, and Health Literacy

In this study, we examined the effects of perceived source credibility of the Centers for Disease Control (CDC) and college student health literacy in predicting the likelihood of enacting preventative behaviors related to mitigating COVID-19. Using the Health Belief Model (HBM) as an explanatory tool, we analyzed how perceived source credibility and health literacy levels predict college students’ likelihood to enact preventative behaviors during a public health crisis. Sample population entirely consisted of undergraduate students enrolled in a basic communication course at a large, southern university. The participants completed survey questionnaires about their perceived health literacy, health beliefs, trust in the CDC, perceptions of COVID-19, and demographic measures during the fall 2020 semester. A multiple regression analysis revealed that (a) HBM predictors, health literacy and CDC source credibility accounted for 44% of the variance in likelihood of enacting preventative health behaviors, and (b) health literacy, CDC source credibility, and perceived severity were all positive predictors of enacting preventative health behaviors, while (c) perceived barriers negatively predicted enactment of preventative health behaviors. Perceived susceptibility and perceived benefits were not significant predictors of college student risk mitigation. Our data suggests the importance of health literacy and source credibility in predicting college students’ likelihood to enact preventative behaviors during public health crises.

Public awareness, specific knowledge, and worry about mpox (monkeypox): A preliminary community-based study in Shenzhen, China

Background

The mpox (monkeypox) outbreak has been declared to be a public health emergency of international concern by the Director-General of World Health Organization in July 2022. However, evidence regarding the awareness, knowledge, and worry about mpox in the general population remains scant.

Methods

A community-based survey targeting community residents was preliminarily conducted in Shenzhen, China in August 2022 by using a convenience sampling method. Information on mpox-related awareness, knowledge, and worry was collected from each participant. Binary logistic regression analyses with the stepwise procedure were applied to explore the factors associated with awareness, knowledge, and worry about mpox.

Results

A total of 1028 community residents were included in the analysis (mean age: 34.70 years). Among these participants, 77.9% had ever heard of mpox, and 65.3% were aware of the global outbreak of mpox. However, only about half of them had a high level of knowledge regarding mpox (56.5%) and related symptoms (49.7%). More than one-third of them (37.1%) expressed a high level of worry about mpox. Having high knowledge levels of mpox and related symptoms were positively associated with a high level of worry (OR: 1.79, 95%CI: 1.22~2.63 for a single high knowledge level; OR: 1.98, 95%CI: 1.47~2.66 for both high knowledge levels).

Conclusions

This study identified the gaps in public awareness and specific knowledge of mpox in Chinese people, providing scientific evidence for the prevention and control network of mpox at the community level. Targeted health education programs are of urgent need, which should be implemented along with psychological interventions to release public worry if necessary.

The Role of General Attitudes and Perceptions Towards Vaccination on the Newly-Developed Vaccine: Results From a Survey on COVID-19 Vaccine Acceptance in China

Background

Vaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019 (COVID-19), it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine.

Objective

This study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example.

Method

A cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine.

Results

The prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A “no hesitancy” attitude toward vaccination is a significant determinant (aOR = 1.77, 95% CI = 1.36–2.31) of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine.

Conclusion

General attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present.

What drives willingness to receive a new vaccine that prevents an emerging infectious disease? A discrete choice experiment among university students in Uganda

Background

There is a critical need to identify the drivers of willingness to receive new vaccines against emerging and epidemic diseases. A discrete choice experiment is the ideal approach to evaluating how individuals weigh multiple attributes simultaneously. We assessed the degree to which six attributes were associated with willingness to be vaccinated among university students in Uganda.

Methods

We conducted a single-profile discrete choice experiment at Makerere University in 2019. Participants were asked whether or not they would be vaccinated in 8 unique scenarios where attributes varied by disease risk, disease severity, advice for or against vaccination from trusted individuals, recommendations from influential figures, whether the vaccine induced indirect protection, and side effects. We calculated predicted probabilities of vaccination willingness using mixed logistic regression models, comparing health professional students with all other disciplines.

Findings

Of the 1576 participants, 783 (49.8%) were health professional students and 685 (43.5%) were female. Vaccination willingness was high (78%), and higher among health students than other students. We observed the highest vaccination willingness for the most severe disease outcomes and the greatest exposure risks, along with the Minister of Health’s recommendation or a vaccine that extended secondary protection to others. Mild side effects and recommendations against vaccination diminished vaccination willingness.

Interpretation

Our results can be used to develop evidence-based messaging to encourage uptake for new vaccines. Future vaccination campaigns, such as for COVID-19 vaccines in development, should consider acknowledging individual risk of exposure and disease severity and incorporate recommendations from key health leaders.

The effects of social-media based social comparison information and similarity mindsets on COVID-19 vaccination uptake cognitions

Vaccine hesitancy—delays in vaccine uptake when one is readily available—is an important public health issue. During the COVID-19 pandemic, the role of psychosocial factors in influencing cognitions and behaviors related to vaccine uptake have been examined. Using an online sample of unvaccinated U.S. adults (N = 300), we examined the influence of COVID-19-related social media-based comparison information (e.g., others’ attitudes about taking the vaccine)—as well as the moderating impact of (dis)similarity mindsets and indirect influence of affective associations, norm perceptions, and self-evaluations of efficacy—on vaccination uptake intentions. Participants reported higher intentions for vaccine uptake following exposure to cautious comparison models (e.g., those that engaged in health prevention behaviors, intended to get vaccinated) versus risky comparison models (e.g., those who did not engage in health prevention behaviors, did not intend to get vaccinated) and neutral comparison models and this effect was indirect through positive affective associations about taking the vaccine. There were no main or interactive effects of (dis)similarity mindsets. Understanding the psychosocial factors that influence health cognitions and behaviors in the context of an infectious disease pandemic will advance theoretical development and aid in creating interventions targeting vaccine uptake.

Health Beliefs in Association with Behaviors in Compliance with COVID-19 Public Health Guidelines: A Cross-sectional Study

This study investigated the preventive health behaviors against the COVID-19 outbreak in Turkey according to the health belief model. The relationships between perceived susceptibility, severity, benefits, barriers, and preventive health behaviors were examined. 1401 participants consisting of 992 (70.8%) females and 409 (29.3%) males participated in an online survey. Independent groups t-test, hierarchical regression analysis and Process Macro were used for analyses. The findings showed that women perceived higher levels of severity of the disease and the benefits of preventive health behaviors than men. Men perceived more barriers to preventive health behaviors. The levels of anxiety and preventive health behaviors of women were higher than men. In regression analysis, male gender and perceived barriers were found as risk factors for preventive health behaviors. However, female gender, perceived severity, and benefits were protective factors for preventive health behaviors. People with low and moderate anxiety levels were more likely to comply with preventive health behaviors.

Factors associated with Turkish pharmacists' intention to receive COVID-19 vaccine: an observational study

Background Pharmacists have been taking part in vaccination services during the COVID-19 pandemic. However, research identifying pharmacists’ intention to get COVID-19 vaccine is limited. Aim The objective of this study was to determine the intention to receive COVID-19 vaccine and to identify the factors related to it based on the Health Belief Model framework among Turkish pharmacists. Method This is an observational study conducted between December 2020 and January 2021. The online survey was sent to all hospital and community pharmacists working in Turkey. Transtheoretical Model of Behaviour Change and Health Belief Model were used for the development of the questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with the intention to receive COVID-19 vaccine. Results Among all participants (n = 961), 74.7% had an intention to receive the COVID-19 vaccine. In model 1, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were associated with their intention to receive the COVID-19 vaccine (p < 0.05). In model 2, the intention to receive COVID-19 vaccine was associated with being male, years of experience in the professional field, not having contracted COVID-19, having a pharmacy staff who had contracted COVID-19, and having had received seasonal flu shot within the previous year (p < 0.05). Conclusion This study highlights the factors related to the intention of the pharmacists to receive COVID-19 vaccines. Health Belief Model is the strongest predictor for vaccination intention and could be used to develop behavioural change techniques to promote vaccination.

Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis

Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in vaccination intentions will be influenced by beliefs around vaccines to influence health. Often perceptions of what others are doing and the information available guide individuals' behaviors for vaccination. This is more so in the digital age with the influence of the internet and media. This study aims to determine the factors that impact willingness to vaccinate for COVID-19. We examined factors associated with acceptance of vaccine based on (1) constructs of the Health Belief Model (HBM), (2) sources of information, (3) social media usage, (4) knowledge of COVID-19 treatment, and (5) perception of government's efforts for mitigation. Randomly sampled online survey data was collected by a global firm between December 2020 and January 2021 from 372 citizens (with a response rate of 96.6%) from multiple regions, including North America, the Middle East, Europe, and Asia. Ordered probit regression suggests that the health belief model constructs hold. Perceived severity of COVID-19 (P < 0.001) and action cues of others taking the vaccine positively influences a subject's vaccine intent (P < 0.001), perceived benefits and perceived efficacy of the vaccine positively influences a subject's vaccine intent (P < 0.001). Perceived barriers negatively influence vaccine intent (P < 0.001). Interestingly as for media usage, mainstream media (e.g., TV, newspaper) (P = 0.006) and social media (P = 0.013) both negatively influence a subject's vaccine intent. Social media platforms that are more entertainment and social-based, such as Whatsapp, Instagram, and YouTube, have a negative and significant influence on vaccine intent (P = 0.061), compared to other more information-based social media platforms (e.g., Twitter, LinkedIn). Knowledge of COVID-19 treatment positively influences vaccine intent (P = 0.023). Lastly, governmental efforts' perceived reliability in mitigation strategy (P = 0.028) and response efforts (P = 0.004) negatively influence vaccine intent. The study highlights the "wait-and-see" action cue from others and leaders in the community. It also informs the importance of shaping media information for vaccination through informative media and social media outlets to counteract any misinformation.

Rapid review of virus risk communication interventions: Directions for COVID-19

OBJECTIVE

In response to COVID-19, we conducted a rapid review of risk communication interventions to mitigate risk from viruses to determine if such interventions are efficacious.

METHODS

We searched for risk communication interventions in four databases: Medline, PsycInfo, the ProQuest Coronavirus Research Database, and CENTRAL. The search produced 1572 articles. Thirty-one articles were included in the final review.

RESULTS

Results showed risk communication interventions can produce cognitive and behavior changes around viruses. Results were more consistently positive for interventions focused on HIV/AIDS as compared to influenza. There was no consistent best intervention approach when comparing peer health, audio/visual, and intensive multi-media interventions. Tailoring risk communication toward a target population, in comparison to not tailoring, was related to better outcomes.

CONCLUSION

The results suggest that risk communication interventions can be efficacious at reducing risk from viruses. They also highlight the complexity of risk communication interventions. Additional research is needed to understand the mechanisms that lead risk communication to reduce risk from viruses.

PRACTICAL VALUE

Results support risk communication interventions to reduce risk from viruses.

COVID-19 Pandemic Worry and Vaccination Intention: The Mediating Role of the Health Belief Model Components

Given the negative consequences of the ongoing COVID-19 pandemic on public health, his study aimed at investigating: (1) the differences between adults with and without chronic illness in buying behavior, vaccination intention, pandemic worry, and the health belief model (HBM) components; (2) the HBM components as mediators of the relationship between pandemic worry and vaccination intention. The sample consisted of 864 adults (66.6% females, M_age = 47.61, SD = 9.23), of which 20.5% reported having a chronic illness. Associations between pandemic worry, vaccination intention, and HBM were ascertained using correlation and mediation analyses. Individuals with chronic illness reported a higher level of pandemic worry, higher levels of perceived threat, greater benefits from vaccination, had lower self-efficacy and bought more medicine and sanitary/hygienic products. No significant differences were observed regarding vaccination intention, barriers against vaccination, and changes in food buying behavior. We found that the relationship between pandemic worry and vaccination intention was partially mediated by the perceived threat of disease and the benefits of vaccination. Pandemic worry predicted vaccination intention directly but also through the contribution of the perceived threat of disease and the benefits of vaccination. These findings suggest that presenting evidence of COVID-19 vaccine efficacy and the benefits of having the vaccine (especially for vulnerable groups, such as chronic illness patients) will encourage the population to follow vaccination recommendations.

Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018-2019

To control the rise in Neisseria meningitidis strain W infections, during 2018–2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13–18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease, the MenACWY vaccination, vaccinations in general, and their MenACWY vaccination intentions. Using random forest analysis, we studied predictions of vaccination intentions by knowledge and beliefs. Survey response rate was 52.8% among teenagers and 59.4% among parents. MenACWY vaccination intentions were best predicted by knowledge and beliefs about vaccinations in general, surpassing knowledge and beliefs about meningococcal disease and the MenACWY vaccination. For teenagers, their parents’ intention that the teenager be vaccinated was a strong predictor of the teenagers’ own vaccination intention. To optimize vaccination uptake during future outbreaks, we recommend that communications emphasize the effectiveness and safety of vaccines and continue to focus on parents.

Pandemic Worry and Preventive Health Behaviors During the COVID-19 Outbreak

Objective: As schools are preparing for onsite learning, it is urgently needed to characterize the extent of pandemic worry and to examine predictors of adopting preventive health behaviors of hand washing, face mask wearing, and maintaining social distance among student pharmacists. Methods: An online survey was sent to 326 student pharmacists in the United States. Pandemic worry was measured using a seven-point Likert scale ranging from extremely not afraid of, to extremely afraid of getting COVID-19. The health belief model (HBM) was the theoretical framework of this study. Preventive health behaviors and components of the HBM were also measured using seven-point Likert scales (one indicated extremely unlikely; seven indicated extremely likely). Multivariable linear regression models were used to identify predictors of each behavior. Results: A medium level of pandemic worry (M = 4.2, SD = 1.92) was identified and females reported a higher pandemic worry. Respondents reported that they were extremely likely to wash their hands (M = 6.8, SD = 0.48) and maintain social distance (M = 6.6, SD = 0.92), but were moderately unlikely to wear face masks (M = 2.2, SD = 1.51). Determinants of face mask wearing included pandemic worry, perceived benefits, cue to action, self-efficacy, and being of an Asian American. Perceived barriers were negatively associated with face mask wearing. Conclusion: Strategies should be implemented to reduce the psychological impact of COVID-19 pandemic among student pharmacists. Predictors identified in this study should be incorporated in efforts to improve face mask wearing. Continued monitoring of pandemic worry and preventive health behaviors is of great significance when universities and colleges are for onsite learning.

Perceived effectiveness of public health measures and positive attitudes during a pandemic: a large cross-sectional study in Shanghai, China

OBJECTIVES

Building individuals' positive attitudes during a pandemic is essential for facilitating psychological resilience. However, little is known about how public health measures may improve people's positive attitudes during a pandemic. We investigated the potential mechanism underlying the association between individuals' perceived effectiveness of public health measures and positive attitudes towards the success of pandemic control during the COVID-19 pandemic, by examining the parallel mediating effects of three types of threat appraisals: concerns about contracting the virus, perceived impact of the pandemic on life and estimated duration of the pandemic.

DESIGN, SETTING AND PARTICIPANTS

In February 2020 when the COVID-19 infection was spreading rapidly in China, a large cross-sectional survey was conducted among 132 054 adults from the 16 districts in Shanghai, China.

OUTCOME MEASURES

Perceived effectiveness of the public health measures, positive attitudes towards the success of pandemic control and threat appraisals.

RESULTS

Results of structural equation modelling supported the hypothesised mediation model: perceived effectiveness of public health measures was associated with lower levels of concerns about contracting the virus (β=-0.20), perceived impact of the pandemic (β=-0.13) and perceived duration of the pandemic (β=-0.20), which were then associated with higher levels of positive attitudes towards the success of pandemic control (βs=-0.12 to -0.25).

CONCLUSIONS

The findings suggest that threat appraisals may be important pathways through which individuals' evaluations of prevention strategies may influence their attitudes towards the success of pandemic control. The health authorities should consider reducing people's inappropriate threat appraisals when designing public health policies to facilitate people's positive attitudes during a pandemic.

Trust in experts, not trust in national leadership, leads to greater uptake of recommended actions during the COVID-19 pandemic

Evidence suggests that people vary in their desire to undertake protective actions during a health emergency, and that trust in authorities may influence decision making. We sought to examine how the trust in health experts and trust in White House leadership during the COVID‐19 pandemic impacts individuals' decisions to adopt recommended protective actions such as mask‐wearing. A mediation analysis was conducted using cross‐sectional U.S. survey data collected between March 27 and 30, 2020, to elucidate how individuals' trust in health experts and White House leadership, their perceptions of susceptibility and severity to COVID‐19, and perceived benefits of protecting against COVID‐19, influenced their uptake of recommended protective actions. Trust in health experts was associated with greater perceived severity of COVID‐19 and benefits of taking action, which led to greater uptake of recommended actions. Trust in White House leadership was associated with lower perceived susceptibility to COVID‐19 and was not associated with taking recommended actions. Having trust in health experts is a greater predictor of individuals' uptake of protective actions than having trust in White House leadership. Public health messaging should emphasize the severity of COVID‐19 and the benefits of protecting oneself while ensuring consistency and transparency to regain trust in health experts.

A Perfect Storm? Health Anxiety, Contamination Fears, and COVID-19: Lessons Learned from Past Pandemics and Current Challenges

The novel coronavirus disease 2019 (COVID-19) rapidly spread, becoming a global pandemic with significant health, economic, and social impacts. COVID-19 has caused widespread anxiety, which at healthy levels leads to adaptive, protective behavioral changes. For some individuals, a pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among those with obsessive-compulsive disorder (OCD) and health anxiety. In the present paper, we review past research studies that examined anxiety in response to other disease outbreaks (including Swine Flu, Zika, and Ebola) to serve as a guide for expectable responses to COVID-19. Our review focused on the role of belief-based cognitive variables (obsessive beliefs, contamination cognitions), transdiagnostic processes (disgust sensitivity, anxiety sensitivity, an intolerance of uncertainty), social factors, and environmental/situational variables as contributing factors to excessive concerns about past pandemics. These factors in combination with unique characteristics of the virus (disease, behavioral, social and economic factors) and media consumption might enhance vulnerability to excessive anxiety about COVID-19, in line with a diathesis-stress model. COVID-19 is also unique from past pandemics due to its severity, easy transmissibility, and the nature of prescribed behavioral responses (i.e., hand washing and social distancing). We therefore discuss the ways in which COVID-19 may disproportionately affect individuals with OCD and health anxiety. We conclude with important topics for clinical and research attention to help mental health professionals respond in this time of crisis.

Intolerance of uncertainty as a factor linking obsessive-compulsive symptoms, health anxiety and concerns about the spread of the novel coronavirus (COVID-19) in the United States

The novel coronavirus disease (COVID-19) has had a significant impact on public health, economic activity, and mental health as it spread across the globe. Research from past pandemics links excessive anxiety about illness-related threats with symptoms of health anxiety and obsessive-compulsive disorder (OCD). In the present study, we investigated whether intolerance of uncertainty (IU), a psychological vulnerability factor involved in both OCD and health anxiety, accounts for a portion of the relationship between these symptoms and fear of COVID-19 during the early stages of the outbreak in the Unites States. We administered measures of concern about the spread of COVID-19 (Coronavirus Threat Scale; CTS), health anxiety, and OCD symptoms to a large sample of community adults in the United States (n = 738) recruited through Amazon MTurk. Results revealed that concern about COVID-19 was moderately and positively correlated with both OCD and health anxiety symptoms, as well as IU. Moreover, regression analyses found that IU partially accounted for the connections between concern about the spread of COVID-19 and OCD and health anxiety symptoms. These results highlight IU as a potential mechanism connecting OCD and health anxiety to anxiety about pandemic threats. Clinical implications, limitations, and future directions for research are discussed.

Effect of Income Level and Perception of Susceptibility and Severity of COVID-19 on Stay-at-Home Preventive Behavior in a Group of Older Adults in Mexico City

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (β = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (β = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.

Emotional and Behavioral Consequences of the COVID-19 Pandemic: The Role of Health Anxiety, Intolerance of Uncertainty, and Distress (In)Tolerance

The COVID-19 pandemic represents a worldwide threat to mental health. To optimize the allocation of health care resources, research on specific vulnerability factors, such as health anxiety, intolerance of uncertainty, and distress (in)tolerance, and particularly their effect on the time course of SARS-CoV-2 related anxiety appears crucial for supporting high risk groups suffering from elevated mental distress during the pandemic. N = 887 participants (78.4% female; Mage = 38.15, SD = 17.04) completed an online survey in Germany (April to mid-May 2020), comprising measures of SARS-CoV-2 related anxiety, health anxiety, safety and preventive behavior, intolerance of uncertainty, and distress intolerance. Higher levels of health anxiety pre and during COVID-19 were associated with an initially intensified increase (b = 1.10, p < 0.001), but later on a more rapid dampening (b = -0.18, p < 0.001) of SARS-CoV-2 related anxiety. SARS-CoV-2 related preventive behavior was intensified by both pre (b = 0.06, p = 0.01) and during (b = 0.15, p < 0.001) COVID-19 health anxiety, while reassurance behavior only was associated with health anxiety during COVID-19 (b = 0.14, p < 0.001). Distress intolerance and intolerance of uncertainty did not moderate the relationship between health anxiety and SARS-CoV-2 related anxiety and behavior. The results suggest detrimental effects of health anxiety on the emotional and behavioral response to virus outbreaks.

Hesitant or Not? The Association of Age, Gender, and Education with Potential Acceptance of a COVID-19 Vaccine: A Country-level Analysis

In December 2020, the first COVID-19 vaccines were approved. Despite more than 85 million reported cases and 1.8 million known deaths, millions worldwide say they may not accept it. This study assesses the associations of age, gender, and level of education with vaccine acceptance, from a random sample of 13,426 participants selected from 19 high-COVID-19 burden countries in June 2020. Based on univariable and multivariable logistic regression, several noteworthy trends emerged: women in France, Germany, Russia, and Sweden were significantly more likely to accept a vaccine than men in these countries. Older (≥50) people in Canada, Poland, France, Germany, Sweden, and the UK were significantly more favorably disposed to vaccination than younger respondents, but the reverse trend held in China. Highly educated individuals in Ecuador, France, Germany, India, and the US reported that they will accept a vaccine, but higher education levels were associated with lower vaccination acceptance in Canada, Spain, and the UK. Heterogeneity by demographic factors in the respondents' willingness to accept a vaccine if recommended by employers were substantial when comparing responses from Brazil, Ecuador, France, India, Italy, Mexico, Poland, Russia, South Africa, South Korea, Sweden, and the US. This information should help public health authorities target vaccine promotion messages more effectively.