Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia

How was the coronavirus vaccine accepted on Twitter? A computational analysis using big data in Japan

Purpose

This study aims to reveal how the COVID-19 vaccine was accepted in the Japanese Twitter-sphere. This study explores how the topics related to the vaccine promotion project changed on Twitter and how the topics that were likely to spread changed during the vaccine promotion project.

Design/methodology/approach

The computational social science methodology was adopted. This study collected all tweets containing the word “vaccine” using the Twitter API from March to October 2021 and conducted the following analysis: analyzing frequent words and identifying topics likely to spread through the cosine similarity and Tobit model.

Findings

First, vaccine hesitancy–related words were frequently mentioned during the vaccine introduction and dissemination periods and had diffusing power only during the former period. Second, vaccine administration–related words were frequently mentioned and diffused through April to May and had diffusing power throughout the period. The background to these findings is that the sentiment of longing for vaccines outweighed that of hesitancy toward vaccines during this period.

Originality/value

This study finds that the timing of the rise in vaccine hesitation sentiment and the timing of the start of vaccine supply were misaligned. This is one of the reasons that Japan, which originally exhibited strong vaccine hesitancy, did not face vaccine hesitancy in the COVID-19 vaccine promotion project.

Vaccine Hesitancy: Contemporary Issues and Historical Background

Vaccination, despite being recognized as one of the most effective primary public health measures, is viewed as unsafe and unnecessary by an increasing number of individuals. Anxiety about vaccines and vaccination programs leading to vaccine hesitancy results from a complex mix of social and political influences, cultural and religious beliefs, the availability of and ability to interpret health and scientific information, and personal and population experiences of health systems and government policies. Vaccine hesitancy is becoming a serious threat to vaccination programs, and was identified as one of the World Health Organization’s top ten global health threats in 2019. The negative impact of anti-vaccination movements is frequently cited as one of the major reasons for rising vaccine hesitancy amongst the general public world-wide. This review discusses the various issues surrounding vaccine hesitancy and the anti-vaccine movement, starting with the definitions of vaccine hesitancy and the anti-vaccine movement in their early history and in the modern era, before discussing the key drivers of vaccine hesitancy, particularly across different regions of the world, with a focus on various countries with low-, middle-, or high-income economies with different socio-economic populations. The review concludes with the impact of vaccine hesitancy on herd immunity and social, psychological, and public health measures to counter vaccine hesitancy.

Strategies to overcome vaccine hesitancy: a systematic review

BACKGROUND

Vaccination, albeit a necessity in the prevention of infectious diseases, requires appropriate strategies for addressing vaccine hesitancy at an individual and community level. However, there remains a glaring scarcity of available literature in that regard. Therefore, this review aims to scrutinize globally tested interventions to increase the vaccination uptake by addressing vaccine hesitancy at various stages of these interventions across the globe and help policy makers in implementing appropriate strategies to address the issue.

METHODS

A systematic review of descriptive and analytic studies was conducted using specific key word searches to identify literature containing information about interventions directed at vaccine hesitancy. The search was done using PubMed, Global Health, and Science Direct databases. Data extraction was based on study characteristics such as author details; study design; and type, duration, and outcome of an intervention.

RESULTS

A total of 105 studies were identified of which 33 studies were included in the final review. Community-based interventions, monetary incentives, and technology-based health literacy demonstrated significant improvement in the utilization of immunization services. On the other hand, media-based intervention studies did not bring about a desired change in overcoming vaccine hesitancy.

CONCLUSION

This study indicates that the strategies should be based on the need and reasons for vaccine hesitancy for the targeted population. A multidimensional approach involving community members, families, and individuals is required to address this challenging issue.

Changing Perspectives on Pediatric Human Papillomavirus (HPV) Vaccination among Dental Students and Residents Reveals Recent Increase in Vaccine Hesitancy

This study was a retrospective analysis of previously collected anonymous survey data regarding vaccine awareness, beliefs, and knowledge among dental (DMD) students and postgraduate (PG) residents. The protocol for this study was approved by the Institutional Review Board (IRB) as exempt. A total of 341 responses were collected from n = 293 DMD students and n = 48 PG residents. Although most respondents agreed that vaccines were necessary, safe, and effective, over the past 4 years (2017-2020) a growing percentage of respondents disagreed. In addition, although most respondents disagreed that there are too many required vaccines, vaccines can make you sick, or are dangerous, a growing percentage of respondents now agreed with these statements. Finally, although most respondents were aware of the HPV vaccine, recently a growing percentage of both students and residents reported they had insufficient information about this vaccine. These results provide novel insights into recent changes in attitudes and beliefs regarding vaccination among this population. Moreover, analysis of these shifts in attitudes and knowledge about HPV vaccination suggests that curricular integration of vaccine research and hesitancy may be needed to answer these questions in a supportive learning environment that fosters critical thinking and evidence-based practice and decision making.

Better Late Than Never: Predictors of Delayed COVID-19 Vaccine Uptake in Poland

In this study, regression models were created to explain the increase of COVID-19 vaccination rates in 378 Polish sub-regions. In order to trace the factors that could explain the willingness to delay vaccination, vaccination rates were compared for age groups of 20 years and more for 30 June 2020 and 31 January 2021. Initially high vaccination rates, rather than leading to the gradual exhaustion of the pool of those wishing to get vaccinated, were a very good predictor of the share of the remainder willing to do so, which increased the divergence between sub-regions in nominal vaccination rates. Support for Eurosceptic and anti-establishment parties was a strong predictor of persistent vaccine hesitancy. Ideological divergence from the mainstream appeared to reinforce vaccine hesitancy, and this relationship remained highly relevant even when controlling for possible time or spatial lag. Markers of social inclusion and social capital—voter turnout and employment rate—remained statistically significant even when controlling for time lag, thus implying clear relevance of trust in the public message. The share of the population with higher education remained a highly relevant factor as well, though in the 20–39 age bracket it predicted a higher vaccination rate, while in all older brackets it was a negative predictor—this implies that those people had already made up their minds. Delaying vaccination seems predominantly explainable by political views, as well as social exclusion and the historical specificity of sub-regions. On a regional level, there was actually a paradoxical Spearmans Rho correlation (0.641) between the share of population refusing mandatory vaccination for kids and the percentage of people receiving a COVID-19 vaccine, which further undermines the idea that overall observed vaccine hesitancy was in any meaningful way affected by anti-vaccine movements.

Better Late Than Never: Predictors of Delayed COVID-19 Vaccine Uptake in Poland

In this study, regression models were created to explain the increase of COVID-19 vaccination rates in 378 Polish sub-regions. In order to trace the factors that could explain the willingness to delay vaccination, vaccination rates were compared for age groups of 20 years and more for 30 June 2020 and 31 January 2021. Initially high vaccination rates, rather than leading to the gradual exhaustion of the pool of those wishing to get vaccinated, were a very good predictor of the share of the remainder willing to do so, which increased the divergence between sub-regions in nominal vaccination rates. Support for Eurosceptic and anti-establishment parties was a strong predictor of persistent vaccine hesitancy. Ideological divergence from the mainstream appeared to reinforce vaccine hesitancy, and this relationship remained highly relevant even when controlling for possible time or spatial lag. Markers of social inclusion and social capital—voter turnout and employment rate—remained statistically significant even when controlling for time lag, thus implying clear relevance of trust in the public message. The share of the population with higher education remained a highly relevant factor as well, though in the 20–39 age bracket it predicted a higher vaccination rate, while in all older brackets it was a negative predictor—this implies that those people had already made up their minds. Delaying vaccination seems predominantly explainable by political views, as well as social exclusion and the historical specificity of sub-regions. On a regional level, there was actually a paradoxical Spearmans Rho correlation (0.641) between the share of population refusing mandatory vaccination for kids and the percentage of people receiving a COVID-19 vaccine, which further undermines the idea that overall observed vaccine hesitancy was in any meaningful way affected by anti-vaccine movements.

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.

A Narrative Review of COVID-19 Vaccines

The COVID-19 pandemic has shaken the world since early 2020 and its health, social, economic, and societal negative impacts at the global scale have been catastrophic. Since the early days of the pandemic, development of safe and effective vaccines was judged to be the best possible tool to minimize the effects of this pandemic. Drastic public health measures were put into place to stop the spread of the virus, with the hope that vaccines would be available soon. Thanks to the extraordinary commitments of many organizations and individuals from around the globe and the collaborative effort of many international scientists, vaccines against COVID-19 received regulatory approval for emergency human use in many jurisdictions in less than a year after the identification of the viral sequence. Several of these vaccines have been in use for some time; however, the pandemic is still ongoing and likely to persist for the foreseeable future. This is due to many reasons including reduced compliance with public health restrictions, limited vaccine manufacturing/distribution capacity, high rates of vaccine hesitancy, and the emergence of new variants with the capacity to spread more easily and to evade current vaccines. Here we discuss the discovery and availability of COVID-19 vaccines and evolving issues around mass vaccination programs.

Vaccine Hesitancy and Political Populism. An Invariant Cross-European Perspective

Vaccine-hesitancy and political populism are positively associated across Europe: those countries in which their citizens present higher populist attitudes are those that also have higher vaccine-hesitancy rates. The same key driver fuels them: distrust in institutions, elites, and experts. The reluctance of citizens to be vaccinated fits perfectly in populist political agendas because is a source of instability that has a distinctive characteristic known as the “small pockets” issue. It means that the level at which immunization coverage needs to be maintained to be effective is so high that a small number of vaccine-hesitants have enormous adverse effects on herd immunity and epidemic spread. In pandemic and post-pandemic scenarios, vaccine-hesitancy could be used by populists as one of the most effective tools for generating distrust. This research presents an invariant measurement model applied to 27 EU + UK countries (27,524 participants) that segments the different behaviours found, and gives social-marketing recommendations for coping with the vaccine-hesitancy problem when used for generating distrust.

Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective

BACKGROUND

The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance.

OBJECTIVE

The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter.

METHODS

We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes.

RESULTS

An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis.

CONCLUSIONS

The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines.

What Demographic, Social, and Contextual Factors Influence the Intention to Use COVID-19 Vaccines: A Scoping Review

BACKGROUND

During the COVID-19 crisis, an apparent growth in vaccine hesitancy has been noticed due to different factors and reasons. Therefore, this scoping review was performed to determine the prevalence of intention to use COVID-19 vaccines among adults aged 18-60, and to identify the demographic, social, and contextual factors that influence the intention to use COVID-19 vaccines.

METHODS

This scoping review was conducted by using the methodological framework for scoping review outlined by Arksey and O'Malley. A search strategy was carried out on four electronic databases: PubMed, Scopus, CINAHL, and PsycINFO. All peer-reviewed articles published between November 2019 and December 2020 were reviewed. Data were extracted to identify the prevalence of, and factors that influence, the intention to use COVID-19 vaccines.

RESULTS

A total of 48 relevant articles were identified for inclusion in the review. Outcomes presented fell into seven themes: demographics, social factors, vaccination beliefs and attitudes, vaccine-related perceptions, health-related perceptions, perceived barriers, and vaccine recommendations. Age, gender, education level, race/ethnicity, vaccine safety and effectiveness, influenza vaccination history, and self-protection from COVID-19 were the most prominent factors associated with intention to use COVID-19 vaccines. Furthermore, the majority of studies (n = 34/48) reported a relatively high prevalence of intention to get vaccinated against COVID-19, with a range from 60% to 93%.

CONCLUSION

This scoping review enables the creation of demographic, social, and contextual constructs associated with intention to vaccinate among the adult population. These factors are likely to play a major role in any targeted vaccination programs, particularly COVID-19 vaccination. Thus, our review suggests focusing on the development of strategies to promote the intention to get vaccinated against COVID-19 and to overcome vaccine hesitancy and refusal. These strategies could include transparent communication, social media engagement, and the initiation of education programs.

A Proposed Approach for Conducting Studies That Use Data From Social Media Platforms

The prominence of social media in contemporary society has extended significantly into the health care arena, where both patients and health care providers have used social media platforms to gather, communicate, learn, and share medical content and personal experience in real time. The medical literature has also seen an exponential increase in the number of studies that use data derived from social media coverage of various medical issues and topics. In this guide, we present a step-by-step framework for health care professionals and researchers to conduct studies that use data from social media platforms. We present 6 overarching steps: focus on framing a question that is appropriate for social media evaluation, identification of social media outlet and selection criteria of content, systematic data extraction, assessment of quality of content and sources of bias, analysis of data, and interpretation of study findings. Each step is illustrated with published examples.

Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy

Background

In Italy, in recent years, vaccination coverage for key immunizations as MMR has been declining to worryingly low levels, with large measles outbreaks. As a response in 2017, the Italian government expanded the number of mandatory immunizations introducing penalties to unvaccinated children’s families. During the 2018 general elections campaign, immunization policy entered the political debate with the government in-charge blaming oppositions for fuelling vaccine scepticism. A new government (formerly in the opposition) established in 2018 temporarily relaxed penalties and announced the introduction of forms of flexibility.

Objectives and methods

First, we supplied a definition of disorientation, as the “lack of well-established and resilient opinions among individuals, therefore causing them to change their positions as a consequence of sufficient external perturbations”. Second, procedures for testing for the presence of both short and longer-term collective disorientation in Twitter signals were proposed. Third, a sentiment analysis on tweets posted in Italian during 2018 on immunization topics, and related polarity evaluations, were used to investigate whether the contrasting announcements at the highest political level might have originated disorientation amongst the Italian public.

Results

Vaccine-relevant tweeters’ interactions peaked in response to main political events. Out of retained tweets, 70.0% resulted favourable to vaccination, 16.4% unfavourable, and 13.6% undecided, respectively. The smoothed time series of polarity proportions exhibit frequent large changes in the favourable proportion, superimposed to a clear up-and-down trend synchronized with the switch between governments in Spring 2018, suggesting evidence of disorientation among the public.

Conclusions

The reported evidence of disorientation for opinions expressed in online social media shows that critical health topics, such as vaccination, should never be used to achieve political consensus. This is worsened by the lack of a strong Italian institutional presence on Twitter, calling for efforts to contrast misinformation and the ensuing spread of hesitancy. It remains to be seen how this disorientation will impact future parents’ vaccination decisions.

Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia

Background

There is widespread hesitancy towards COVID-19 vaccines in the United States, United Kingdom, and Australia.

Objective

To identify predictors of willingness to vaccinate against COVID-19 in five cities with varying COVID-19 incidence in the US, UK, and Australia.

Design

Online, cross-sectional survey of adults from Dynata’s research panel in July-September 2020.

Participants, setting

Adults aged 18 and over in Sydney, Melbourne, London, New York City, or Phoenix.

Main outcomes and measures

Willingness to receive a COVID-19 vaccine; reason for vaccine intention.

Statistical methods

To identify predictors of intention to receive a COVID-19 vaccine, we used Poisson regression with robust error estimation to produce prevalence ratios.

Results

The proportion willing to receive a COVID-19 vaccine was 70% in London, 71% NYC, 72% in Sydney, 76% in Phoenix, and 78% in Melbourne. Age was the only sociodemographic characteristic that predicted willingness to receive a COVID-19 vaccine in all five cities. In Sydney and Melbourne, participants with high confidence in their current government had greater willingness to receive the vaccine (PR = 1.24; 95% CI = 1.07–1.44 and PR = 1.38; 95% CI = 1.74–1.62), while participants with high confidence in their current government in NYC and Phoenix were less likely to be willing to receive the vaccine (PR = 0.78; 95% CI = 0.72–0.85 and PR = 0.85; 95% CI = 0.76–0.96).

Limitations

Consumer panels can be subject to bias and may not be representative of the general population.

Conclusions

Success for COVID-19 vaccination programs requires high levels of vaccine acceptance. Our data suggests more than 25% of adults may not be willing to receive a COVID-19 vaccine, but many of them were not explicitly anti-vaccination and thus may become more willing to vaccinate over time. Among the three countries surveyed, there appears to be cultural differences, political influences, and differing experiences with COVID-19 that may affect willingness to receive a COVID-19 vaccine.

Multi-domain narrative review of vaccine hesitancy in childhood

Vaccine hesitancy, where individuals delay or refuse some or all vaccines, is a perennial problem. It undermines the success of the immunisation programmes and places the society, especially vulnerable populations such as children, at risk of contracting infectious diseases. The phenomenon has been extensively analysed based on four aspects - confidence, complacency, convenience and costs. We suggest the alternative use of a multi-dimensional framework adapted from the "Generalist Wheel of Knowledge, Understanding and Inquiry" that was developed by Prof Larry Green and Kurt Stange, to assess the multiple facilitators and barriers towards vaccine hesitancy in childhood vaccination. The framework identifies domains in the healthcare system namely the child and parent/family, the clinician, the healthcare system and policy, and the infectious disease and corresponding vaccine that influence vaccine hesitancy. This narrative review includes literature beyond those covered by the World health Organisation Global Vaccine Action Plan (WHO GVAP). It identifies emotional distress, past negative experience and misconceptions that contribute to vaccine hesitancy in children and family, while attitude and motivation underpin vaccine hesitancy in clinicians. The healthcare system contributes to vaccine hesitancy when enforcements, diligent monitoring and transparency are absent or lacking. Inefficient dissemination of information about the disease and its associated vaccine as well as inadequate surveillance of misinformation add to vaccine hesitancy. The inter-domain factors highlight the roles of relationship between the clinician, child and parent, information mastery of the clinician, prioritisation of resources and equity in combating vaccine hesitancy. Using this framework, we present evidence-based strategies which have been effective in mitigating vaccine hesitancy for each domain and their corresponding inter-domains. By providing new perspectives of a complex problem and its potential solutions, this narrative review aims to complement and support the WHO GVAP by developing a coordinated multi-domain strategy to mitigate vaccine hesitancy in childhood.

Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases

Despite major advances in vaccination over the past century, resurgence of vaccine-preventable illnesses has led the World Health Organization to identify vaccine hesitancy as a major threat to global health. Vaccine hesitancy may be fueled by health information obtained from a variety of sources, including new media such as the Internet and social media platforms. As access to technology has improved, social media has attained global penetrance. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns raised by anti-vaccination messaging on such platforms and the consequent potential for downstream vaccine hesitancy, including the compromise of public confidence in future vaccine development for novel pathogens, such as SARS-CoV-2 for the prevention of COVID-19. In this review, we discuss the current position of social media platforms in propagating vaccine hesitancy and explore next steps in how social media may be used to improve health literacy and foster public trust in vaccination.

The State of Vaccine Confidence in Poland: A 2019 Nationwide Cross-Sectional Survey

Vaccination is considered as one of the most successful and cost-effective public health interventions. This study aimed to assess (1) the attitudes and behaviors towards mandatory childhood vaccination, with particular emphasis on socio-economic factors determining the vaccine confidence among adults in Poland as well as to (2) identify the potential impact of anti-vaccination movement on vaccination coverage among children and adolescents aged ≤19 years. This cross-sectional study was carried in 2019 on a nationwide, representative sample of 1079 individuals aged 18 and over in Poland (53.7% females). Most of the respondents (74.6%) agreed or strongly agreed that mandatory vaccinations are safe, and only 8% of participants neglected the safety of vaccines. The results of multivariate analysis showed that the lowest level of vaccine confidence was observed among participants aged 25–34 years (aOR: 0.48, 95%CI: 0.29–0.80; p = 0.01). There was a positive correlation (r = 0.35; p < 0.001) between trust in doctors and vaccine confidence. Moreover, there was a positive correlation between trust in scientific knowledge and vaccine confidence (r = 0.19; p < 0.001). Also, a negative correlation (r = −0.13; p < 0.001) between trust in horoscopes and vaccine confidence was observed. Most of the parents declared (97.7%), that their children were vaccinated following the national immunization programme. However, 8.5% of parents who currently vaccinated their children declared that they would stop vaccinating children when vaccination obligation will be abolished. This study demonstrates relatively high confidence in mandatory vaccination among adults in Poland. While most of society trusts in vaccine safety, young adults are the least trustful of vaccinations.

President Trump and health care: a content analysis of misleading statements

Background

This study examines President Trump’s misleading language in the area of health care. According to ‘The Washington Post’, President Trump has made over 10 000 misleading or false statements about public policy.

Methods

We use content analysis to examine the 662 health-related statements made over the period from his inauguration on 20 January 2017 to 27 April 2019.

Results

Analysis of these statements identified seven themes, and we also found that a plurality of the statements spreads false information about the Affordable Care Act or Obamacare.

Discussion

President Trump’s misleading statements about health care are unprecedented and potentially damaging to public health. The communications may adversely affect the public’s knowledge about their health care, their understanding of the health care system and their understanding of health care procedures.