'Corona is coming': COVID-19 vaccination perspectives and experiences amongst Culturally and Linguistically Diverse West Australians

Factors associated with vaccination intention and uptake over time in a sample of older Australians

This study sought to identify the behavioural and social drivers of vaccination in 16,745 older Australians. We analysed and compared influences on COVID-19 vaccination intention and uptake using prospectively collected survey data from the Sax Institute's 45 and Up Study. Vaccination intention increased with older age (adjusted odds ratio [aOR]:1.03; 95 % confidence interval [CI]: 1.01-1.04; p = .002), a belief that the vaccine is important for the person's own health (aOR: 5.17; 95 % CI: 4.23-6.24; p < .001), is safe (aOR:2.64; 95 % CI: 2.19-3.2; p < .001), and trusted by the person (aOR:6.79; 95 % CI: 5.59-8.26 p < .001); concern about contracting COVID-19 (aOR:1.78; 95 % CI: 1.47-2.17; p < .001); having enough information about COVID-19 vaccines (aOR:1.99; 95 % CI: 1.65-2.29; p < .001); a belief that most adults will receive a COVID-19 vaccine (aOR:2.31; 95 % CI: 1.93-2.77; p < .001); and a belief that family and friends wanted the person to receive a COVID-19 vaccine (aOR:6.07; 95 % CI: 5.06-7.27; p < .001). The same factors contributed to increased vaccine uptake, with the exception of age and the belief that the person had enough information about the vaccine. Concern that the vaccine will cause a serious reaction was associated with both lower intention (aOR:0.35; 95 % CI: 0.29-0.43; p < .001) and lower uptake (aOR:0.61; 95 % CI: 0.46-0.81; p < .001) while lower intention was also associated with low decisional autonomy (aOR:0.37; 95 % CI: 0.22-0.62; p < .001). Intentions changed over time and a change towards vaccination was associated with perceptions of vaccine safety. Access barriers played a role in the non-vaccination of otherwise intending older Australians. Messaging that is adaptive to safety concerns, emphasises vaccine benefits, leverages social norms, and targets people who make decisions for older Australians may be helpful for influencing vaccination intentions and increasing vaccine uptake.

From speculative to real: community attitudes towards government COVID-19 vaccine mandates in Western Australia from May 2021 to April 2022

Many governments employed mandates for COVID-19 vaccines, imposing consequences upon unvaccinated people. Attitudes towards these policies have generally been positive, but little is known about how discourses around them changed as the characteristics of the disease and the vaccinations evolved. Western Australia (WA) employed sweeping COVID-19 vaccine mandates for employment and public spaces whilst the state was closed off from the rest of the country and world, and mostly with no COVID-19 in the community. This article analyses WA public attitudes during the mandate policy lifecycle from speculative to real. Qualitative interview data from 151 adults were analysed in NVivo 20 via a novel chronological analysis anchored in key policy phases: no vaccine mandates, key worker vaccine mandates, vaccine mandates covering 75% of the workforce and public space mandates. Participants justified mandates as essential for border reopening and, less frequently, for goals such as protecting the health system. However, public discourse focusing on 'getting coverage rates up' may prove counter-productive for building support for vaccination; governments should reinforce end goals in public messaging (reducing suffering and saving lives) because such messaging is likely to be more meaningful to vaccination behaviour in the longer term.

COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake

Recent studies have used the World Health Organization's new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework's limitations regarding the centrality of the state in shaping people's vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state's role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals' willingness to engage. Government systems that leave some populations behind increase those populations' susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients' trust, especially in the context of vaccine mandates. Reframing the state's responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, "Recentering the State in Vaccine Uptake," arising from our analyses.

The experience of traumatic events, psychological distress, and social support: links to COVID-19 vaccine hesitancy and trends with age in a group of older Australians

BACKGROUND

Vaccination is important to reduce disease-associated morbidity and mortality in an ageing global population. While older adults are more likely than younger adults to accept vaccines, some remain hesitant. We sought to understand how traumatic events, psychological distress and social support contribute to older adults' intention to receive a COVID-19 vaccine and whether these experiences change with age.

METHODS

We analysed survey data collected as part of the Sax Institute's 45 and Up Study in a population of Australian adults aged 60 years and over. Data were derived from the COVID Insights study; a series of supplementary surveys about how participants experienced the COVID-19 pandemic.

RESULTS

Higher intention to receive a COVID-19 vaccine was associated with greater social support (adjusted odds ratio (aOR):1.08; 95%CI:1.06-1.11; p <.001) while lower intention was associated with personally experiencing a serious illness, injury or assault in the last 12 months (aOR:0.79; 95% CI:0.64-0.98; p =.03). Social support and the experience of traumatic events increased significantly with age, while psychological distress decreased.

CONCLUSIONS

There may be factors beyond disease-associated risks that play a role in vaccine acceptance with age. Older Australians on the younger end of the age spectrum may have specific needs to address their hesitancy that may be overlooked.

Exploring the reasons behind low COVID-19 vaccination coverage in ethnic minorities-A qualitative study among Arabic-speaking public in Denmark

AIMS

In Denmark, COVID-19 infection rates have been higher, and vaccination coverage has been lower in areas with many residents from ethnic minority backgrounds. This study aimed to explore COVID-19 vaccination perceptions among Arabic-speaking minorities in Denmark.

MATERIALS AND METHODS

A total of 16 individuals, varying in age, gender, education, employment, health, vaccination status, and the Arabic-speaking country of origin, were recruited and interviewed in Arabic. The interviews were transcribed verbatim, translated into English, and analyzed using directed thematic analysis.

RESULTS

Most interviewees had some knowledge about how vaccines work to prevent infections; however, a wide spectrum of opinions about the effectiveness and safety of COVID-19 vaccines and vaccination policies in Denmark emerged. COVID-19 vaccination issues were extensively discussed in Arabic-speaking communities, but consensus was rarely reached. Many participants felt confused and only took vaccines for practical considerations, such as travel. Due to language barriers, some participants experienced difficulties in understanding vaccination-related information in electronic invitations from the health authorities and at vaccination centers, with family members often stepping in to provide translations.

CONCLUSIONS

Systematic efforts to actively disseminate translated COVID-19 vaccination information are needed to support ethnic minority individuals in making informed decisions.

West Australian parents' views on vaccinating their children against COVID-19: a qualitative study

BACKGROUND

Australian children and adolescents were among the last local cohorts offered COVID-19 vaccines. Despite promising initial uptake, coverage subsequently plateaued, requiring further efforts to improve access and build parents' recognition of the importance of COVID-19 vaccination. We sought to understand West Australian (WA) parents' willingness to vaccinate their children to inform strategies for improving uptake at the time in which they were becoming eligible.

METHODS

We undertook in-depth qualitative interviews with 30 parents of children aged 5-17 years from June - December 2021. During this period, children aged 12-15 years became eligible for vaccination; children aged 5-11 years became eligible shortly thereafter. Data were thematically analysed in NVivo.

RESULTS

Most parents intended on vaccinating their children once eligible. Parents sought to protect their children, to protect the community, to resume travel, and to get back to "normal". They reflected that vaccination against key infectious threats is a routine activity in childhood. Some were concerned about the vaccine, particularly mRNA vaccines, being new technology or impacting fertility. "Wait-awhiles" wanted to see what other parents would do or were delaying until they felt that there was a higher risk of COVID-19 in WA. Most parents of younger children wanted their child to be vaccinated at the general practice clinic due to familiarity and convenience. Parents were particularly eager for clear and consistent messaging about vaccination of children and adolescents, including safety, importance, scientific evidence, and personal stories.

CONCLUSION

For future pandemic vaccinations pertaining to children, governments and health officials need to address parents' concerns and meet their preferences for the delivery of the vaccine program to children and adolescents.

'I'm provax': Pro-vaccination personal histories and socialities of older Australians in the COVID-19 pandemic

Vaccination scholarship often explores how social networks foster vaccine refusal and delay, revealing how social and institutional relations produce refusing or delaying parents and un- or under-vaccinated children. It is likewise critical to understand the development of pro-vaccination orientations by researching those who want to be vaccinated since such attitudes and associated practices underpin successful vaccination programmes. This article explores pro-vaccination sociality, personal histories and self-understandings during the COVID-19 pandemic in Australia. We draw upon 18 in-depth interviews with older Western Australians, documenting how they articulate 'provax' identities in opposition to those they depict as 'antivax' others. Provax identities were clearly anchored in and solidified through social relations and personal histories, as interviewees spoke of 'likeminded' friends and families who facilitated each other's vaccinations and referenced childhood experiences of epidemics and vaccinations. Access barriers relating to the vaccine programme drove interviewees to reimagine their provax status in light of not yet being vaccinated. Thus, interviewees' moral and ideological understandings of themselves and others were interrelated with supply-side constraints. We examine the development of self-proclaimed 'provaxxers' (in a context of limited access); how they imagine and enact boundaries between themselves and those they deem 'antivax'; and possibilities for public health research.

Codesign and community outreach to create COVID-19 safe communities: A Karen community case study

During the COVID-19 pandemic, government directives for health and community services focused on building capacity for COVID-19 safe behaviors. During 2020-2021, there was mounting pressure to increase vaccination numbers to boost population-wide immunity, thereby enabling the lessening of pandemic response restrictions. The Australian population, in general, faced communication hurdles in understanding COVID-19, government directives and policies, and health initiatives. This was particularly challenging given the rapid changes in disease behaviors and community response requirements. This community case study documents local experience in delivering information about COVID-19 safety and vaccination to a former refugee community (the Karen community) in regional Victoria. Community outreach and codesign approaches established closer engagement between the Karen community and Bendigo Community Health Services (BCHS). This case study is explored through semi-structured interviews conducted face-to-face and via videoconferencing with key Karen community leaders, Karen community members, vaccination clinic volunteers, and BCHS staff and bicultural workers. A hybrid approach that employed community outreach and codesign approaches in tandem built trust and closer ties between the Karen community and BCHS, leading to increased understanding and compliance with COVID-19 safe messages and vaccination uptake. Community-led innovations included codesign of COVID-19 fact sheets and videos in the Karen language, involvement of "local champions," assisting Karen businesses with COVID-19 safe plans, and creation of a COVID-19 information hotline. The latter was facilitated by BCHS bicultural staff. These innovations supported the delivery of vaccination clinics at the local Karen Temple. Embedding multi-level, tailored, and responsive public health approaches is particularly important in complex settings where there are disproportionately high levels of community disadvantage, as occurred during the COVID-19 pandemic.