Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India - a community based survey

From Hesitancy to Acceptance: An Interpretative Approach to Unravel the Vaccination Motivation Among the Rural Population

Our study focuses on vaccination decisions within a collectivistic framework, prioritizing social and behavioral factors over individualistic views amidst COVID-19. Integrating behavioral biases and social ties, we inform targeted public health communication strategies. Examining vaccine uptake in rural India, we use Interpretative Phenomenological Analysis (IPA) to interpret deviations, capturing personal experiences and biases. Through the COM-B model and 25 interviews, we uncover motivations influenced by individual, family, and community factors. Synthesizing findings, we propose tailored public health communication grounded in behavioral psychology. Rather than disregarding biases, we explore their implications for effective interventions. This research advances health communication, particularly benefiting lower-middle-income countries with non-pharmacological approaches.

Exploring COVID-19 vaccine hesitancy among young adults in Australia. A qualitative study

Background

COVID-19 vaccine hesitancy among young adults in Australia is still poorly understood. Young adults aged 25-34 years have been identified as a population subgroup where COVID-19 vaccine-hesitant views are highly prevalent.

Objective

Exploring the attitudes, thoughts, feelings and social environments affecting the decision to have or not have the vaccine can provide vital transferrable lessons in future health campaigns.

Methods

A qualitative phenomenological study was conducted using semi-structured phone interviews between June 2021 and July 2021. Interview questions were adopted from the World Health Organization's guidance document 'Data for Action: Achieving High Uptake of COVID-19 Vaccines'. Participants aged 25-34 years (n = 26) were recruited via purposive and snowball sampling methods. Data were analysed thematically.

Results

Overall, participants presented themselves as highly vaccine literate, understanding their social contract with society. Many participants also did not display traditional vaccine-hesitant views. Six themes specifically regarding COVID-19 vaccine hesitancy were identified, namely (1) decision-making complexities, (2) perceived risk of COVID-19 infection, (3) media's misrepresentation of COVID-19, (4) vaccine-related issues, (5) inconsistent government messaging and program execution, and (6) social benefits assessment. In addition, motivators to COVID-19 vaccine uptake were classified into three categories: (1) tangible benefits, (2) protecting others, and (3) mandates and incentives. Findings suggest the motivators for COVID-19 vaccine uptake in young adults depend on individual benefits, highlighting the importance of recognising and addressing personal concerns.

Conclusion

There is a need to re-examine and redefine the meaning of vaccine hesitancy in young Australian adults. We offer an understanding of prospective challenges with vaccine hesitancy and potential solutions to address them. These include carefully tailored approaches regarding ongoing vaccine safety concerns and the expected personal benefits following vaccination. Combining these factors can aid in developing new methods of public engagement in the next public health crisis.

COVID-19 and influenza vaccine-hesitancy subgroups

Health communicators are faced with the challenge that people can hesitate vaccines for different reasons. Our aim was to identify and describe the qualities of distinct COVID-19 and influenza vaccine-hesitancy subgroups to facilitate the development of tailored vaccine-hesitancy communication. In two studies, we used agglomerative hierarchical cluster analysis to identify COVID-19 (N = 554) and influenza (N = 539) vaccine-hesitancy subgroups in the general population based on nine vaccine hesitancy-related variables (intent to get vaccinated, perceived vaccine safety, perceived vaccine efficacy, perceived disease threat, perceived vaccination responsibility, perceived vaccination convenience, distrust in authorities, conspiracy mentality, and reliance on anecdotal testimonies). We identified and described six distinct COVID-19 vaccine-hesitancy subgroups (the Vaccination Positive, the Ambivalent, the Fearing Skeptic, the Unconvinced, the Constrained Skeptic, and the Vaccination Opponent), and three influenza vaccine-hesitancy subgroups (the Vaccination Positive, the Complacent, and the Vaccination Opponent), with different levels of hesitancy. We discuss the implications of the results for health communicators. Our results shed light on the (dis)similarities between people who hesitate COVID-19 and influenza vaccines and suggest that there is greater variety in hesitancy concerning COVID-19 vaccinations than influenza vaccinations. These findings can be used to design and test tailored vaccination messages.

Relative contribution of biomedical, demographic, and socioeconomic factors to COVID-19 vaccine receipt in rural India

BACKGROUND

In the first year of roll-out, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevented almost 20 million deaths from coronavirus disease 2019 (COVID-19). Yet, little is known about the factors influencing access to vaccination at the individual level within rural poor settings of low-income countries. The aim of this study was to examine determinants of vaccine receipt in rural India.

METHODS

A census of a rural village in Tamil Nadu was undertaken from June 2021 to September 2022. We surveyed 775 participants from 262 households. Household-level data on socioeconomic status (SES), water, sanitation, and hygiene practices, and individual-level demographic information, travel history, and biomedical data, including anthropometry, vital signs, and comorbidities, were collected. Logistic regression models with 5-fold cross-validation were used to identify the biomedical, demographic, and socioeconomic determinants of vaccine receipt and the timing of receipt within the first 30 days of eligibility. Vaccine ineligible participants were excluded leaving 659 eligible participants. There were 650 eligible participants with complete biomedical, demographic, and socioeconomic data.

RESULTS

There were 68.0% and 34.0% of individuals (N = 650) who had received one and two vaccine doses, respectively. Participants with household ownership of a permanent account number (PAN) or ration card were 2.15 (95% CI:1.32-3.52) or 3.02 (95% CI:1.72-5.29) times more likely to receive at least one vaccine dose compared to households with no ownership of such cards. Participants employed as housewives or self-employed non-agricultural workers were 65% (95% CI:0.19-0.67) or 59% (95% CI:0.22-0.76) less likely to receive at least one vaccine dose compared to salaried workers. Household PAN card ownership, occupation and age were linked to the timing of vaccine receipt. Participants aged ≤18 and 45-60 years were 17.74 (95% CI:5.07-62.03) and 5.51 (95% CI:2.74-11.10) times more likely to receive a vaccine within 30 days of eligibility compared to 19-44-year-olds. Biomedical factors including BMI, vital signs, comorbidities, and COVID-19 specific symptoms were not consistently associated with vaccine receipt or timing of receipt. No support was found that travel history, contact with COVID-19 cases, and hospital admissions influenced vaccine receipt or timing of receipt.

CONCLUSION

Factors linked to SES were linked to vaccine receipt, more so than biomedical factors which were targeted by vaccine policies. Future research should explore if government interventions including vaccine mandates, barriers to vaccine access, or peer influence linked to workplace or targeted vaccine promotion campaigns underpin these findings.

COVID-19 vaccine hesitancy, trust, and communication in Sarlahi District, Nepal

BACKGROUND

Strategies to increase COVID-19 vaccine coverage require an understanding of the extent and drivers of vaccine hesitancy and trust in government related to COVID-19 vaccine programs, especially in low-resource communities.

METHODS

We conducted a cross-sectional household survey post-COVID-19 vaccine introduction among adults (n = 362) in four municipalities in Sarlahi District, Nepal from August to December 2022. The survey included modules on participant demographics and socioeconomic factors and vaccine hesitancy, information seeking, and trust in authorities related to COVID-19 vaccination.

RESULTS

Of the study participants, 38.4 % expressed hesitancy related to COVID-19 vaccination. The adjusted odds of being "vaccine hesitant" were significantly lower among the older adults (51+ years) relative to younger (<30 years) (aOR: 0.49, CI: 0.24-0.97) and among males relative to females (aOR: 0.51, CI: 0.26, 0.95). The study population highly trusted the government's handling of the COVID-19 pandemic. While for most, self-reported access to vaccination opportunities was high (88.4 %), 70.4 % of participants did not know if vaccines were in stock at their local vaccination facility. Commonly reported statements of misinformation include the vaccine being developed in a rush or too fast (21.5 %), COVID-19 infection can be effectively treated with ayurvedic medicine(16.3 %) and obtaining immunity from natural infection is better than through vaccination (19.9 %). The primary sources of information on COVID-19 programs were family and friends (98.6 %), healthcare professionals (67.7 %), Female Community Health Volunteers (FCHVs) (61.9 %), television (56.4 %), and radio (43.1 %).

CONCLUSION

Although many respondents expressed concerns about COVID-19 effectiveness and safety, a high proportion trusted COVID-19 information provided by healthcare workers and approved of the government's response to the pandemic. This study highlights an opportunity to design new evidence-based communication strategies to improve vaccine confidence delivered through frontline government healthcare workers. Approaches could be targeted to certain communities in the region shown to have higher vaccine hesitancy, including younger people and women.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

Corona virus vaccine hesitancy among higher education students in Adama City, Oromia, Ethiopia

Background

Vaccination stands as the most efficient approach for managing the continued transmission of infections and preventing the emergence of novel variants. Coronavirus disease 2019 (COVID-19) vaccine hesitancy poses a significant burden in the fight to achieve herd immunity.

Methods

A cross-sectional study, based on institutional parameters, was conducted among a cohort of 530 higher education students, selected via a simple random sampling method. Study participants were selected using a systematic random sampling technique from February to March 2022. Structured questionnaire data were gathered and subsequently analyzed using SPSS version 21. The strength of the association between various factors and COVID-19 vaccine hesitancy was assessed using the odds ratio along with its 95% confidence interval. Statistical significance was deemed to be present at a p-value of < 0.05.

Result

The prevalence of coronavirus vaccine hesitancy was 47.5%. The factors that were found to be significantly associated with COVID-19 vaccine hesitancy were residential address (AOR = 2.398, 95% CI: 1.476-3.896); agreeing with leaders and groups that do not support COVID-19 vaccination (AOR = 2.292, 95% CI: 1.418-3.704); coming from a community whose leaders support COVID-19 vaccination for young adults (AOR = 0.598, 95% CI: 0.381-0.940), and believing that COVID-19 vaccines are safe (AOR = 0.343,95% CI: 0.168-0.701).

Conclusion

Approximately five out of 10 students who participated in this study were hesitant to get vaccinated against coronavirus. Incorporating messages and initiatives into local plans to specifically target the factors identified in this study is imperative for substantially increasing the COVID-19 vaccine uptake among students in higher education institutions.

Emergency Approval Mechanisms for Human Vaccines in India

The coronavirus disease 2019 (COVID-19) pandemic highlighted the world's level of preparedness in managing public health emergencies (PHEs). It revealed the critical need for timely medical therapeutics, especially vaccines. To expedite response, many nations, including India, adopted emergency approval mechanisms and offered new ways of review, such as the rolling review along with the accelerated review procedure. This response resulted in reallocating internal resources and adopting new policies and measures, such as integrating digital technology with regulatory submissions and flexibility in statistical approaches. The present review focuses on the utilization of the New Drugs and Clinical Trials Rules 2019 for granting emergency approval to COVID-19 vaccines by the Drug Controller General of India (DCGI) and explores the legislative basis for such authorization during the PHE. The review aims to elucidate key intricacies and challenges inherent in the existing 'emergency use' framework within the Indian regulatory landscape. It assesses three critical facets of the 'emergency use' paradigm: the definition of the term, establishment of a transparent decision-making process, and formulation of rules governing termination or expiration of the emergency status. It makes policy recommendations regarding the 'emergency use' framework to respond to new, emerging, or re-emerging public health threats of the future.

COVID-19 vaccine acceptance and hesitancy in Indian context: a systematic review and meta-analysis

Vaccination against COVID-19 is vital for achieving herd immunity, and the Government of India has adopted several strategies to achieve coverage. Vaccine hesitancy was identified as a potential obstacle in combating COVID-19. This study aimed to review the COVID-19 vaccine acceptance and hesitancy, and factors associated with vaccine hesitancy based on studies conducted in Indian populations. The data sources (PubMed, Scopus, and Google Scholar) were searched by following PRISMA guidelines, and the search was done in September 2022. We performed a meta-analysis through a random effect model to estimate pooled hesitancy rate with 95% confidence intervals (CI). A total of 3,339 records were searched, of which 46 studies were found to be eligible for inclusion in the review. The included studies covered 65,551 respondents, 55% were female. Studies reported COVID-19 vaccine acceptance rate of 65.7% in January-February 2021, which increased to 92.8% in May-August 2021. Likewise, the rate of vaccine hesitancy in December 2020 was 37%, dropping to 12.1% through November 2021. The estimated pooled COVID-19 vaccine hesitancy was 31% [95% CI: 27% - 36%, I2 = 99.3%]. Most studies highlighted that fear of the vaccine's side effects, efficacy, and safety were major barriers to vaccine acceptance. However, as the review indicates, it is important to consider and address all factors contributing to vaccine hesitancy.

Factors associated with COVID-19 vaccine uptake and hesitancy among healthcare workers in the Democratic Republic of the Congo

Vaccination is a critical intervention to reduce morbidity and mortality and limit strain on health systems caused by COVID-19. The slow pace of COVID-19 vaccination uptake observed in some settings raises concerns about COVID-19 vaccine hesitancy. The Democratic Republic of the Congo experienced logistical challenges and low uptake at the start of vaccine distribution, leading to one of the lowest overall COVID-19 vaccine coverage rates in the world in 2021. This study assessed the magnitude and associated factors of COVID-19 vaccine uptake among healthcare workers (HCWs) in seven provinces in DRC. We implemented a cross-sectional Knowledge, Attitudes, and Practices (KAP) questionnaire targeting HCWs, administered by trained data collectors in Haut-Katanga, Kasaï Orientale, Kinshasa, Kongo Centrale, Lualaba, North Kivu, and South Kivu provinces. Data were summarized and statistical tests were performed to assess factors associated with vaccine uptake. HCWs across the seven provinces completed the questionnaire (N = 5,102), of whom 46.3% had received at least one dose of COVID-19 vaccine. Older age, being married, being a medical doctor, being a rural resident, and having access to or having previously worked in a COVID-19 vaccination site were all strongly associated with vaccination uptake. Vaccinated individuals most frequently cited protection of themselves, their families, and their communities as motivations for being vaccinated, whereas unvaccinated individuals were most concerned about safety, effectiveness, and risk of severe side effects. The findings suggest an opinion divide between vaccine-willing and vaccine-hesitant HCWs. A multidimensional approach may be needed to increase the acceptability of the COVID-19 vaccine for HCWs. Future vaccine campaign messaging could center around the positive impact of vaccination on protecting friends, family, and the community, and also emphasize the safety and very low risk of adverse effects. These types of messages may further be useful when planning future immunization campaigns with new vaccines.

COVID-19 vaccine hesitancy: assessing the prevalence, predictors, and effectiveness of a community pharmacy based counseling intervention

BACKGROUND

Coronavirus disease (COVID-19) vaccine hesitancy is a global challenge. In low- and middle-income countries (LMICs), the problem has persisted despite vaccine availability and decreasing infections. In Uganda, there is still limited information on the extent and predictors of vaccine hesitancy. This study sought to assess the prevalence and predictors of COVID-19 vaccine hesitancy, and the effectiveness of an intervention that involved community pharmacy counseling in combating COVID-19 vaccine hesitancy.

METHODS

A total of 394 participants were enrolled in a 4-week prospective cohort interventional study. The study was conducted across eight community pharmacies in Mbarara City, between 9:00 AM and 5:00 PM daily. The study personnel ascertained the vaccination status of all clients seeking community pharmacy services. All unvaccinated clients were consecutively assessed for eligibility, and eligible clients were systematically enrolled after receiving the community pharmacy services for which they requested. The study intervention involved structured participant counseling (within the pharmacy premise), follow-up short message service (weekly), and telephone calls (bi-weekly). Only participants who did not accept to receive the COVID-19 vaccine despite counseling were followed up for four weeks, or until they accepted to receive a COVID-19 vaccine. The effectiveness of the community pharmacy counseling intervention was determined as an increase in COVID-19 vaccine acceptance, and desirable attitudinal change towards COVID-19 disease, vaccination exercise, and vaccines. Descriptive analysis was used to summarize data, and multivariate analysis was used to determine the predictors of COVID-19 vaccine hesitancy. A p-value < 0.05 was considered statistically significant.

RESULTS

Out of 394 participants, 221 (56%) were hesitant to receive a COVID-19 vaccine. Participants expressed several reasons (mean 2±1) for COVID-19 vaccine hesitancy, mostly concerning vaccine safety (N=160, 47.3%). The overall COVID-19 vaccine acceptance rate increased by 25.4 percent points (43.9 - 69.3 percent points) after the study intervention. Age, religion, level of education, distance from the nearest public health facility, having a friend/family diagnosed with COVID-19, and personal suspicion of contracting COVID-19 were significant predictors of COVID-19 vaccine hesitancy.

CONCLUSION

COVID-19 vaccine hesitancy is a big challenge in Uganda. A mix of sociodemographic and COVID-19 vaccine perceptions are the key predictors of COVID-19 vaccine hesitancy. Although COVID-19 vaccines were not available at the time of the study, this study found that structured counseling interventions can improve COVID-19 vaccine acceptance rates. Larger prospective studies should evaluate the effectiveness of similar interventions in community pharmacies and other healthcare settings.

A Scoping Review and Taxonomy of Epidemiological-Macroeconomic Models of COVID-19

OBJECTIVES

The COVID-19 pandemic placed significant strain on many health systems and economies. Mitigation policies decreased health impacts but had major macroeconomic impact. This article reviews models combining epidemiological and macroeconomic projections to enable policy makers to consider both macroeconomic and health objectives.

METHODS

A scoping review of epidemiological-macroeconomic models of COVID-19 was conducted, covering preprints, working articles, and journal publications. We assessed model methodologies, scope, and application to empirical data.

RESULTS

We found 80 articles modeling both the epidemiological and macroeconomic outcomes of COVID-19. Model scope is often limited to the impact of lockdown on health and total gross domestic product or aggregate consumption and to high-income countries. Just 14% of models assess disparities or poverty. Most models fall under 4 categories: compartmental-utility-maximization models, epidemiological models with stylized macroeconomic projections, epidemiological models linked to computable general equilibrium or input-output models, and epidemiological-economic agent-based models. We propose a taxonomy comparing these approaches to guide future model development.

CONCLUSIONS

The epidemiological-macroeconomic models of COVID-19 identified have varying complexity and meet different modeling needs. Priorities for future modeling include increasing developing country applications, assessing disparities and poverty, and estimating of long-run impacts. This may require better integration between epidemiologists and economists.

Factors affecting the community's attitude toward COVID-19 vaccination: cross-sectional study

OBJECTIVE

The study aimed to analyze the factors that affect the community's attitude towards COVID-19 vaccination in Tangerang District.

METHODS

A cross-sectional study was used. Convenience sampling was used to select 400 respondents. Inclusion criteria are living in Tangerang District, aged between 18 and 55, and earning a living. An online questionnaire was used and passed validity and reliability tests. This study received ethical approval.

RESULTS

Most respondents had a high level of education (48.50%), low income (72.50%), high knowledge (78%), and a positive attitude (76.50%) regarding vaccination against COVID-19. The Chi-square test revealed a correlation between knowledge and attitudes towards COVID-19 vaccination (p=0.001), as well as education levels (p=0.001), but there was no correlation between income and attitudes (p=0.094).

CONCLUSIONS

Health professionals should engage in extensive socialization and face-to-face visits with people with limited access to information to promote a positive attitude and expand the scope of COVID-19 vaccination.

A Study on Community needs, perceptions and demand regarding the use of the health services during COVID-19 pandemic in district Kathua, J and K

Introduction

The impact of the COVID-19 pandemic on essential health services is a source of great concern. Health gains made during the last 2-3 decades have been halted due to shifting of resources to fight the COVID-19 pandemic.

Aim and Objective

This study was conducted to identify community needs, demands, and perceptions regarding the effectiveness of using health services during the pandemic.

Methodology

This was a qualitative study which was conducted through focus group discussions. The participants comprised of three groups: community leaders, healthcare providers, and field workers. Discussion among the participants was conducted using the standardized World Health Organization community assessment tool.

Result

In our study, it was reported that most of the essential health services were disrupted due to COVID-19 pandemic. The barriers to accessing essential health services have been exacerbated and the provision of community-based services is effected due to this. In regard to COVID-19 vaccination also, there remain individuals who are reluctant to be vaccinated.

Conclusion

Our study shows that the community faced barriers in accessing and using health services during the pandemic. To ensure the public's access to health services and strengthen healthcare preparedness strategies like health budget allocation, manpower, infrastructure, trainings, integration with primary healthcare, etc., need to be carried out during and after the pandemic. Thus, participation and inter-sectoral coordination across levels are required to overcome these barriers.

Factors for hesitancy towards vaccination against COVID-19 among the adult population in Puducherry, India - a cross sectional study

BACKGROUND

Vaccine hesitancy is a complex phenomenon that threatens global health. Present-day communication technology has paved the way for self-education but also contributed to the infodemic surrounding vaccination. This has resulted in pockets of people who are reluctant, refuse recommended vaccinations, or choose to delay being vaccinated. The present study was designed to estimate the magnitude of hesitancy towards the COVID-19 vaccination and determine its associated factors in the community.

METHODS

This cross-sectional study was conducted among 776 adults aged ≥ 18 years in 15 clusters in Puducherry district, India, between March 2022 and May 2022. Face-to-face interviews were conducted using a validated, structured questionnaire. Socio-demographic variables, co-morbidities, attitudes towards vaccination, etc., were expressed as frequencies and percentages. Vaccine hesitancy was dichotomized with the median score as the cut-off and reported as a proportion with a 95% confidence interval. Univariate and multivariate analyses were carried out to determine the factors associated with vaccine hesitancy.

RESULTS

The mean age of participants was 43.3 ± 14.8 years, with the majority being female (67.0%). Nearly 92.4%, 74.4%, and 0.5% of participants received their first, second, and precautionary doses, respectively, during the study period. Among the unvaccinated, 93.2% were unwilling to receive any dose of vaccination. More than half of the participants were hesitant towards vaccination, according to the vaccine hesitancy scale. Participants aged above 45 years were less hesitant, while those educated up to school level, belonging to the upper socio-economic class, never tested for COVID-19 in the past, and having a negative attitude towards vaccination were significantly associated with higher vaccine hesitancy.

CONCLUSIONS

It is imperative to address vaccine hesitancy by alleviating existing fears and misconceptions in the community through efficient communication strategies to win the fight against current as well as future public health emergencies.

Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.

Double Jab: Survey Evidence on Vaccine Hesitancy, Beliefs, and Attitudes in India

India witnessed a large surge in COVID-19 cases in April 2021, a second wave of nearly 350,000 daily new infections across the country. As of December 2021, cases have reduced drastically, in part due to greater vaccine coverage across the country. This study reports results on vaccine hesitancy, attitudes, and behaviors from an online survey conducted between February and March 2021 in nine Indian cities (N = 518). We find that vaccine hesitancy negatively predicts willingness to take the vaccine, and beliefs about vaccine effectiveness supersede hesitancy in explaining vaccine uptake. Furthermore, we find that mask-wearing and handwashing beliefs, information sources related to COVID-19, and past COVID-19 infection and testing status are all strongly associated with the hypothetical choice of vaccine. We discuss these findings in the context of behavioral theories as well as outline implications for vaccine-related health communication in India.

COVID-19 Vaccine Hesitancy: A Content Analysis of Nigerian YouTube Videos

Vaccination is key to developing herd immunity against COVID-19; however, the attitude of Nigerians towards being vaccinated stalled at the 70% vaccination target. This study engages Theory of Planned Behaviour to analyse the tone of Nigerian YouTube headlines/titles, and the tone of YouTube users' comments to examine the causes of COVID-19 vaccine hesitancy. YouTube videos uploaded between March 2021 and December 2022 were analysed using a content analytic approach. Results show 53.5% of the videos had a positive tone, while 40.5% were negative, and 6% neutral. Second, findings indicate most of the Nigerian YouTube users' comments were neutral (62.6%), while 32.4%, were negative, and 5% were positive. From the antivaccine themes, analysis shows the people's lack of trust in the government on vaccines (15.7%) and the presence of vaccine conspiracy theories mostly related to expressions of religion and biotechnology (46.08%) were the main causes of COVID-19 vaccine hesitancy in Nigeria. The study presents implications for theory and recommends ways for governments to develop better vaccination communication strategies.

Analysis of COVID-19 vaccine uptake among people with underlying chronic conditions in 2022: A cross-sectional study

Background

COVID-19 has been a global burden and vaccinations have proven to be the most effective measure to fight this pandemic. Since the approval and distribution of the vaccines, approximately 75% of District of Columbia residents have been fully vaccinated leaving a quarter of the population at risk. With the availability and approval of the booster doses to people with high-risk chronic conditions, it is important to understand the attitude of people towards vaccinations.

Objective

The objective of this research study is to analyze the COVID-19 vaccination uptake among people with underlying chronic conditions residing in District of Columbia residents and to determine the reason for the hesitancy to perform targeted outreach to unvaccinated populations.

Study design/methods

In 2022, we conducted a cross sectional study via a short online survey that was distributed to the target populations via email and social media. Multivariable Regression Analyses were conducted to determine the factors associated with the acceptance of the vaccination across various demographics.

Results

The findings of the study demonstrate that the acceptance of COVID-19 vaccination was low among people with chronic conditions compared to those with no underlying chronic conditions, and vaccination rates strongly differ based on social determinants like education, employment, and area of residence across District of Columbia.

Conclusion

The public health significance of this study is to understand the reason behind the vaccine hesitancy so that we can work towards building trust, extending outreach, creating targeted health education, and increasing access to vaccination to all communities across District of Columbia.

Perception regarding COVID-19 vaccine and COVID appropriate behavior among adolescents at a tertiary hospital, West Bengal: A longitudinal survey

Background

Vaccination against COVID 19 and observing COVID appropriate behavior are effective measures to control, manage and prevent COVID-19 infection. With India starting its adolescent vaccination program, this study aimed to explore the adolescents' perception of vaccination, their COVID-appropriate behavior, compliance with two doses of COVID-19 vaccines and the experienced side effects following vaccination.

Methods

A longitudinal survey was conducted among 440 adolescents visiting the COVID Vaccination Center (CVC) of a tertiary hospital in West Bengal. In the survey, adolescents were asked about family socio-demographic characteristics, their opinions on COVID-19 vaccines, and COVID-19 Appropriate Behavior (CAB) practices. Voluntary participants were given a questionnaire to fill and a telephonic interview was taken regarding side effects experienced following the vaccination and their compliance to both doses of vaccine.

Results

The majority of adolescents (99.3%) had taken vaccines by their own wish. The reason for willingness to take the vaccine was the fear of being infected with COVID-19 infection (50.5%). Maximum adolescents got information regarding the COVID vaccination program through the internet (41.8%) followed by family members (30.5%). The majority of adolescents (70.9%) had a good perception of COVID-19 vaccination. A significant number of adolescents (44.8%) strongly disagreed with the statement that they don't need to follow COVID appropriate behavior after vaccination.

Conclusion

The majority of adolescents had a good perception regarding COVID-19.

Acceptance, hesitancy and refusal towards COVID-19 vaccination

Problem

The determinants of COVID-19 vaccine acceptance, hesitancy, and refusal remain poorly understood. We assessed the general population of Pune after visiting tertiary care hospital for their willingness to accept the vaccine and the reason for their hesitancy and refusal.

Methodology

A six-month descriptive cross-sectional study with 386 community members over the age of 18 who visited the Tertiary Hospital OPD was conducted. The vaccine acceptance and hesitancy was assessed using a self designed detailed questionnaire with a one-time face-to-face interview.

Results

Acceptance for vaccine was observed in 235 (60.8%) participants, while 151 (39.2%) hesitated and refused. Participants with lower education (P < 0.00001), no employment did not readily accept the vaccine (P < 0.00001). Pregnant, breast-feeding women (21.8%) hesitated vaccine because of lack of evidence regarding vaccine safety. Participants (73.6%) were readily accepting (third dose) booster dose of vaccine when available. The reason for vaccine hesitance was the concern about side effects (58.2%) and reason for acceptance was to get immunity against COVID-19 (76.1%). Vaccine information source appears to be an influential aspect, as participants who obtained vaccination information from healthcare providers had no concerns regarding vaccination.

Conclusion

The study has found a link between average education level, unemployment and vaccine acceptance and hesitancy. Factors influencing vaccine hesitancy include lack of vaccine information, vaccine side effects, and misinformation spread via social media. Clinical pharmacists can play an important role in boosting up vaccine acceptance by providing appropriate information in community.

COVID-19 Pandemic and Vaccination Skepticism

The purpose of this study is to examine some of the reasons why people are skeptical about the COVID-19 vaccination despite assurances from the authorities. In terms of methodological consideration, the study is situated within the qualitative research paradigm. The study adopted interviews and documentary analysis as the main source of data. The themes were generated from the data using the Voyant software, and the empirical discussion based on thematic analysis approach. The study reveals that trust in the COVID-19 vaccines, institutions, and cultural and religious beliefs determines people’s vaccination decisions in a significant manner. The study further highlighted that the quick production and administration of the various COVID-19 vaccines and history of previous epidemics/pandemic’s vaccination programs (such as the side effects of the vaccines) could have made people hesitant towards the COVID-19 vaccination. Furthermore, trust in governments, pharmaceutical companies, and healthcare institutions informs people whether to participate in the COVID-19 pandemic vaccination project. Last but not the least, religious and cultural beliefs have sown seeds of skepticism in people and, ultimately, their COVID-19 vaccination decisions.

Parental hesitancy against COVID-19 vaccination for children and associated factors in Taiwan

Background

Since July 2021, some countries and regions have initiated the vaccination of minors against coronavirus disease (COVID-19), and parental COVID-19 vaccine hesitancy will affect the vaccination of minors. We aimed to identify the level of parental hesitancy to vaccinate their children against COVID-19 in Taiwan and the factors associated with vaccine hesitancy.

Methods

We conducted a population-based, self-administered online questionnaire in Taiwan to assess parental hesitancy and the factors influencing their children’s vaccination against COVID-19.

Results

Among 384 respondents, 64.1% were hesitant to have their children vaccinated against COVID-19. Mothers were more likely to hesitate to vaccinate their teens than their fathers (67.5% vs. 50%, P < 0.005). Multiple regression results showed that parents who were hesitant to vaccinate themselves (OR = 3.81, 95% CI:2.07–7.02) and those who scored lower on their perception of their children’s vaccination (OR = 9.73, 95% CI:5.62–16.84) were more hesitant to vaccinate their children with COVID-19 vaccine.

Conclusions

According to the study findings, 64.1% of Taiwanese parents were hesitant to vaccinate their children against COVID-19. Parents who were hesitant to receive the COVID-19 vaccine for themselves and had negative views of the vaccine for their children were more likely to be hesitant to vaccinate their children. An in-depth discussion of the factors affecting vaccine hesitancy and targeted health education is conducive to promoting vaccination in children with COVID-19.

Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review

As the COVID-19 pandemic continues and transitions to an endemic stage, booster vaccines will play an important role in personal and public health. However, convincing people to take boosters continues to be a key obstacle. This study systematically analyzed research that examined the predictors of COVID-19 booster vaccine hesitancy. A search of PubMed, Medline, CINAHL, Web of Science, and Scopus uncovered 42 eligible studies. Globally, the average COVID-19 booster vaccination hesitancy rate was 30.72%. Thirteen key factors influencing booster hesitancy emerged from the literature: demographics (gender, age, education, income, occupation, employment status, ethnicity, and marital status), geographical influences (country, region, and residency), adverse events, perceived benefit/efficacy, perceived susceptibility, perceived severity, prior history of COVID-19 infection, vaccination status, vaccination recommendations, health status, knowledge and information, skepticism/distrust/conspiracy theories, and vaccine type. Vaccine communication campaigns and interventions for COVID boosters should focus on factors influencing booster confidence, complacency, and convenience.

A new fractional mathematical model to study the impact of vaccination on COVID-19 outbreaks

This study proposes a new fractional mathematical model to study the impact of vaccination on COVID-19 outbreaks by categorizing infected people into non-vaccinated, first dose-vaccinated, and second dose-vaccinated groups and exploring the transmission dynamics of the disease outbreaks. We present a non-linear integer order mathematical model of COVID-19 dynamics and modify it by introducing Caputo fractional derivative operator. We start by proving the good state of the model and then calculating its reproduction number. The Caputo fractional-order model is discretized by applying a reliable numerical technique. The model is proven to be stable. The classical model is fitted to the corresponding cumulative number of daily reported cases during the vaccination regime in India between 01 August 2021 and 21 July 2022. We explore the sensitivities of the reproduction number with respect to the model parameters. It is shown that the effective transmission rate and the recovery rate of unvaccinated infected individuals are the most sensitive parameters that drive the transmission dynamics of the pandemic in the population. Numerical simulations are used to demonstrate the applicability of the proposed fractional mathematical model via the memory index at different values of 0 . 7 , 0 . 8 , 0 . 9 and 1. We discuss the epidemiological significance of the findings and provide perspectives on future health policy tendencies. For instance, efforts targeting a decrease in the transmission rate and an increase in the recovery rate of non-vaccinated infected individuals are required to ensure virus-free population. This can be achieved if the population strictly adhere to precautionary measures, and prompt and adequate treatment is provided for non-vaccinated infectious individuals. Also, given the ongoing community spread of COVID-19 in India and almost the pandemic-affected countries worldwide, the need to scale up the effort of mass vaccination policy cannot be overemphasized in order to reduce the number of unvaccinated infections with a view to halting the transmission dynamics of the disease in the population.

A Qualitative Comparative Analysis to explore the predictors of individuals' willingness towards vaccination

The emergence of COVID-19 traumatized individuals from all walks of life and while the demand for vaccines increased exponentially, the authorities seem to encounter greater challenges on their road to create herd immunity. Governments initiated numerous campaigns to influence individuals to opt for vaccination and India being a diverse country makes it difficult to understand the motivating factors for getting COVID-19 vaccination. The study aimed to explore the predictors of individuals' willingness to get vaccinated using Qualitative Comparative Analysis (QCA). After screening using the vaccine hesitancy scale, a semi-structured interview was conducted among 30 respondents from India. Crisp Set QCA was utilized to analyse the data which lead to nine conditions. A solution combination of seven conditions showed a consistency of 1 and coverage of 0.6. They included knowledge about vaccines, perceived severity of the COVID-19 virus, family and peer influence, media and health department's influence, a sense of social responsibility, trust in the authorities and vaccine efficacy. This study contributes to the relevance of QCA's use in psychological research, especially to identify predictors of willingness to immunize. The findings of this study would help in designing appropriate interventions to enhance willingness to get vaccinated.

Knowledge, attitudes, and factors determining the willingness for COVID-19 vaccination among students in Bangladesh: An online-based cross-sectional study

Aim

The most effective way to avoid COVID-19 is through immunization against the virus that causes the disease. The primary objective of this study was to assess the extent of knowledge, attitudes, acceptability, and factors influencing COVID-19 vaccination acceptance among higher secondary and university students in Bangladesh.

Subject and methods

A structured questionnaire-based online survey was conducted among 451 students residing in Khulna and Gopalganj cities from February to August, 2022. The willingness to accept the COVID-19 vaccine was compared with a few covariates using the chi-square test, and we then used binary logistic regression to identify the determinants that led Bangladeshi students to receive the COVID-19 vaccine.

Results

During the study period, almost 70% of the students obtained immunizations, with 56% of men and 44% of women reporting having done so. The age range of 26-30 years had the highest percentage of students who had received vaccinations, and 83.9% of students agreed that the COVID-19 vaccine is crucial for students. The results of the binary logistic regression clearly show that gender, degree of education, and respondents' willingness, encouragement, and beliefs have a significant impact on students' eagerness to receive COVID-19 vaccination.

Conclusion

The rising trend in vaccination status among Bangladeshi students is highlighted by this study. Additionally, our results eloquently demonstrate that vaccination status varies by gender, education level, willingness, encouragement, and respondent's viewpoint. The outcomes of this study are essential for health policy makers and other interested parties to successfully organize their immunization program for young adults and children at various levels.

Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body's immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.

Barriers to Coronavirus Disease 19 vaccination in patients with obesity

BACKGROUND

Patients with obesity are at a high risk of severe disease and death from Coronavirus Disease 2019 (COVID-19). Vaccination offers a safe and effective means of reducing this risk. The rate of COVID-19 vaccine refusal in patients with obesity is unknown.

METHODS

Patients with obesity were administered validated questionnaires assessing COVID-19 fear, general vaccine hesitancy, and COVID-19-specific vaccine hesitancy.

RESULTS

507 participants completed the study. COVID-19 vaccine hesitancy was high: Fifteen percent of patients refused COVID-19 vaccine. Hesitancy related to other vaccines was also high: Eight percent of patients refused a vaccine in the past, and 15% delayed a vaccine. Fear of side effects and doubts regarding effectiveness were the most common reasons for vaccine refusal.

CONCLUSIONS

Despite high risk for complications, vaccine hesitancy is high among patients with obesity. Targeted public health interventions are critical to reduce vaccine hesitancy and improve vaccination rates.

In or Out? Identifying the Factors Playing a Role in Covid-19 Decision Making in Turkiye

OBJECTIVE

The study aimed at investigating the social, demographic, and economic factors affecting Covid-19 vaccine decisions before the vaccination started in Turkey. The study also aimed to understand the attitudes towards Covid-19 vaccines.

METHODS

The study was conducted by exploiting the data of 693 individuals living in Turkey. The data was collected via a virtually applied questionnaire according to snowball sampling in late 2020 when the vaccination program had not started in Turkey yet. Multinomial logistic regression design was used to identify the factors affecting Covid-19 vaccine decisions.

RESULTS

It was observed that Covid-19 vaccine acceptance was notably low before the vaccination started in Turkey. Further, almost 50% of the participants were indecisive about getting vaccinated. It was identified that age, gender, educational status, and residential status, as well as occupational status, the number of dependents, smoking, and the vaccination of governmental authorities, have associations with Covid-19 vaccination decisions.

CONCLUSIONS

Covid-19 vaccine acceptance is generally low, although it is relatively high among vulnerable groups (i.e., the elderly and smokers), and among those who are unable to isolate themselves. In addition, the vaccination of governmental authorities is remarkably effective on Covid-19 vaccine acceptance in Turkey.

A statistical analysis of tweets on covid-19 vaccine hesitancy utilizing opinion mining: an Indian perspective

The world witnessed the emergence of a deadly virus in December 2019, later named COVID-19. The virus was found to be highly contagious, and so people across the world were highly prone to be affected by the virus. Being a virus-borne disease, developing a vaccine was one of the most promising remedies. Thus, research organizations across the globe started working on developing the vaccine. However, it was later found by many researchers that a large number of people were hesitant to receive the vaccine. This paper aims to study the acceptance and hesitancy levels of people in India and compares them with the acceptance and hesitancy levels of people from the UK, the USA, and the rest of the world by analyzing their tweets on Twitter. For this study, 2,98,452 tweets were fetched from January 2020 to March 2022 from Twitter, and 1,84,720 tweets from 1,22,960 unique users were selected based on their country of origin. Machine learning based Sentiment analysis is then used to evaluate and analyze the tweets. The paper also proposes an NLP-based algorithm to perform opinion mining on Twitter data. The study found the public sentiment of the Indian population to be 63% positive, 28% neutral, and 9% negative. While the worldwide sentiment distribution is 45% positive, 34% neutral, and 21% negative, the USA has 42% positive, 34% neutral, and 23% negative and the UK has 50% positive, 29% neutral, and 21% negative. Also, sentiment analysis for individual vaccines in Indian context resulted in "Covaxin" with the highest positive sentiment at 43% followed by "Covishield" at 36%. The outcome of this work yields an insight into the public perception of the COVID-19 vaccine and thus can be used to formulate policies for existing and future vaccine campaigns. This study becomes more relevant as it is the consolidated opinion of Indian people, which is versatile in nature.

Knowledge, attitude, and practices of front line health workers after receiving a COVID-19 vaccine: a cross-sectional study in Pakistan

Background

Globally, there is an increased risk of COVID-19 infection among front-line health workers (FHW). This study aimed to evaluate the knowledge, attitude, and practices of FHW of Pakistan after receiving the COVID-19 vaccine.

Methods

A population web-based survey on COVID-19 vaccine was conducted on 635 FHW in Pakistan between April 15, 2021, and July 15, 2021. The survey focused on four main sections consisting of socio-demographic data, knowledge, attitude, and practices after receiving the COVID-19 vaccine. The data was analyzed on SPSS. p < 0.05 was considered significant.

Results

Overall, 60% of FHW were nervous before getting vaccinated, with the leading reason to get vaccinated being their concern to protect themselves and their community (53.4%). A majority of FHW had fear about the unseen side effects of the COVID-19 vaccine (59.7%) used in Pakistan, with the most common side effect reported as soreness at the injection site (39%). It has been noted that almost all of the FHW observed preventive practices after getting vaccinated. The results showed that married respondents had favorable practices towards COVID-19 vaccines (B = 0.53, p < 0.01) (B, unstandardized regression coefficient). It was also found that more informational sources (B = 0.19, p < 0.01), higher knowledge of vaccination (B = 0.15, p < 0.001), and favorable attitude toward vaccine (B = 0.12, p < 0.001) significantly predicted favorable practices toward COVID-19 vaccination.

Conclusion

The findings reflect that FHW, though they were worried about its side effects, have good knowledge and a positive attitude after getting the COVID-19 vaccine. This study is significant as the FHWs are a symbol for guidance, a reliable source of information, and an encouraging means of receiving COVID-19 vaccine for the general public. This study also reported that post-vaccination side effects were mild which will aid in reducing the vaccine hesitancy among the general Pakistani population.

Knowledge and Perception of the Employees Towards COVID-19 Vaccination at Palestinian Universities

Introduction

Major efforts are being made to control the spread and impact of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends largely on factors beyond the availability of vaccines.

Objective

This study aimed to investigate the knowledge and perception of university employees towards the COVID-19 vaccination.

Methods

A cross-sectional study was conducted between February and June 2021. A total of 310 university employees from six Palestinian universities participated in the study. A self-reported questionnaire was used for data collection and included the following: personal and medical characteristics of the university employees' knowledge and perception regarding receiving the COVID-19 vaccination.

Results

Three hundred and ten out of 336 questionnaires (92.3% response rate) were completed and returned by the participants. The results revealed that 41.9% of university employees had good knowledge of the COVID-19 vaccination. On the other hand, 51.9% of them had a positive perception of the COVID-19 vaccination. Also, there is a significant difference between the level of knowledge and perception of the COVID-19 vaccine (p < .05).

Conclusion

Less than half of the university employees had good knowledge, and half of them had a positive attitude towards the COVID-19 vaccination. Also, it has been determined that there is a relationship between the level of knowledge and perception of the COVID-19 vaccine. The study recommended that employees should be involved in educational campaigns to increase their knowledge of the importance of vaccines in COVID-19 prevention.

Evaluation of COVID-19 vaccine acceptance and uptake in rural Bangladesh: a cross-sectional study

OBJECTIVE

The objective of this study was to evaluate the acceptance and uptake of COVID-19 vaccines in rural Bangladesh.

DESIGN

This was a cross-sectional study conducted between June and November 2021.

SETTING

This study was conducted in rural Bangladesh.

PARTICIPANTS

People older than 18 years of age, not pregnant and no history of surgery for the last 3 months were eligible to participate.

PRIMARY AND SECONDARY OUTCOMES

The primary outcomes were proportions of COVID-19 vaccine acceptance and roll-out participation among the rural population. The secondary outcome was identification of correlates which contributed to COVID-19 vaccine acceptance and roll-out participation. Χ² tests and multivariable logistic regression analyses were performed to identify relevant correlates such as sociodemographic factors, clinical conditions and COVID-19-related factors.

RESULTS

A total of 1603 participants were enrolled. The overall COVID-19 vaccine acceptance was very high (1521/1601, 95%), and half of the participants received at least one dose of the COVID-19 vaccine. Majority of participants wanted to keep others safe (89%) and agreed to the benefits of COVID-19 vaccines (88%). To fulfil the requirement of online registration for the vaccine at the time, 62% of participants had to visit an internet café and only 31% downloaded the app. Over half (54%) of participants were unaware of countries they knew and trust to produce the COVID-19 vaccine. Increased age, being housewives, underweight and undergraduate education level were associated with vaccine acceptance, while being female, increased age and being overweight/obese were associated with vaccine uptake. Trust in the health department and practical knowledge regarding COVID-19 vaccines were positively associated with both vaccine acceptance and uptake.

CONCLUSION

This study found a very high COVID-19 vaccine acceptance in rural Bangladesh. Policymakers should support interventions aimed at increasing vaccine and general health literacy and ensure ongoing vaccine supply and improvement of infrastructure in rural areas.

Apprehensions and Optimism among Dental Professionals during the COVID-19 Pandemic-A Nationwide Cross-Sectional Evaluation

Globally, the pandemic of the coronavirus disease, which started in Wuhan, China, has become a major issue for public health. The COVID-19 epidemic notably causes health professionals to experience significantly more emotional stress than the general populace. The present study proposes to investigate the fear aspect in dentists in the initiation of clinical practice during these times. An online cross-sectional study was conducted among dental practitioners based on a pre-validated questionnaire. The data were expressed as frequency and percentage analyzed using the chi-square test using SPSS version 25. The data was obtained from 271 participants, where clinical practice after the first wave was mostly by freelancers (p-value = 0.01); most of whom were married (p-value = 0.065); 19.1% attached to institutes did not have changes in earnings; 28.1% of private practitioners had less than 10% reduction in cases. A total of 62% of private practitioners are concerned about the vaccine's preventative effects (p-value = 0.026), and 57% of private practitioners worry about being sued for the delay in treatment (p-value = 0.036). Only 33.1% of employees in institutions worry that becoming sick could endanger their family. As dentists continue to work their way through this pandemic, these pressures only occasionally have an impact on them. According to the researchers, this is the first study that has captured the anxiety and apprehensions that dental practitioners experienced during the height of the COVID-19 outbreak in India in April 2021. The study's findings demonstrate that the study population was generally upbeat and confident that they could quickly overcome their fear.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Development and standardization of a COVID-19 Vaccination Anxiety scale for Adult Urban Indian Population (CVAS-A)

Given the ongoing COVID-19 vaccination drive across the globe, a significant amount of confusion, mistrust, misunderstanding, and hesitancy had surfaced regarding the vaccine. A standardized tool to understand the possible reasons of COVID-19 vaccination anxiety and hesitancy would be valuable in this context. The current study aimed at developing a standardized tool to measure COVID-19 Vaccination Anxiety among Urban Indian adults. A 19-item scale was administered to an Urban adult Indian population (N = 760) between the period of February 2021- May 2021 to obtain factors associated with COVID-19 Vaccination Anxiety and establish reliability estimates of the scale. Infection-related anxiety, information-related anxiety and vaccine side-effect-related anxiety were the three factors determined through Factor Analysis. The scale was validated with Convergent and Discriminant Validity by finding correlation between the three factors of the scale and five factors of the Brief version of the Big-Five personality Inventory (extraversion, agreeableness, openness to experience, conscientiousness, and neuroticism). It is expected that a tool such as CVAS-A would help in understanding and managing COVID-19-related vaccination hesitancy.

Adverse events following immunization associated with coronavirus disease 2019 (COVID-19) vaccines: A descriptive analysis from VigiAccess

This study assessed adverse events following immunizations (AEFIs) reported on COVID-19 vaccines in VigiAccess and determined the reporting trends across all continents of the world. The study was cross-sectional quantitative in design. VigiAccess was searched on 10 November 10 2021 for reported adverse events following the introduction of COVID-19 vaccines. After entering the search term, "COVID-19 vaccines" in VigiAccess, AEFIs associated with nine approved brands of COVID-19 vaccines had been documented in the database. Data were captured among age groups, sex, and continents of the world and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Overall, 2,457,386 AEFIs had been reported in VigiAccess at the time of the search. No causal associations could be established between the vaccines and the AEFIs. The public accessing VigiAccess data should therefore be made aware of this in order to not falsely attribute AEFIs to COVID-19 vaccines when assessing the database.

Exposure to Misinformation, Risk Perception, and Confidence towards the Government as Factors Influencing Negative Attitudes towards COVID-19 Vaccination in Malaysia

INTRODUCTION

This study explored exposure to misinformation, COVID-19 risk perception, and confidence towards the government as predictors of negative attitudes toward the COVID-19 vaccine.

METHODS

A cross-sectional survey was carried out from 30 June to 30 August 2021 involving 775 respondents. The survey instrument for the questionnaire was an adaptation from various different studies consisting of five main variables: (1) misinformation about vaccination; (2) risk perception toward COVID-19; (3) attitudes toward the vaccination programme; (4) intention to get vaccinated; and (5) public confidence in the government in executing the vaccination programme.

RESULTS

The results of this study indicate that higher exposure to misinformation led to higher levels of negative attitudes toward the COVID-19 vaccine. When the perceived risk of COVID-19 infection was high, mistrust of vaccine benefits was low but there were also higher worries about the future effects of the vaccine. Confidence in the government was associated with lower negative attitudes toward the COVID-19 vaccine.

CONCLUSION

The results of this study may help develop an understanding of negative attitudes toward vaccinations in Malaysia and its contributing factors.

Knowledge, attitudes, and practices related to COVID-19 among patients attending public dental clinics in Tanzania: A cross-sectional study

Introduction

The risk of contracting COVID-19 through dental treatment is potentially high, thus several guidelines have been developed to minimize the spread of COVID-19 in the dental office worldwide. These changes have posed some relevant questions among oral health professionals regarding the understanding and attitudes of dental patients toward COVID-19. This study aimed to assess the knowledge, attitude, and practices of dental patients in Dar es Salaam, Tanzania.

Methodology

This cross-sectional study was carried out in 4 public hospitals in Dar es Salaam, Tanzania involving 472 adult patients. Data were collected using a questionnaire that had a set of questions regarding knowledge, attitude, and practices (KAP) related to COVID-19. Data were analyzed using the SPSS computer software version 26. For descriptive analysis means, standard error of the mean, and proportion were used. Multivariate regression analysis was utilized for the response analysis. Alpha of less than 0.05 was considered to indicate statistical significance.

Results

Good levels of knowledge, attitude, and practices related to COVID-19 were found in 76.5%, 74.8%, and 58.1% of participants respectively. On performing multivariate analysis, odds of having good knowledge regarding COVID-19 were almost 2 folds higher in participants who were females, with high education levels, those without partners, and those with stable income. Females were 1.5 folds more likely to have a good attitude toward COVID-19 and odds of good practice against COVID-19 were 3 folds higher in young adults compared to the elderly.

Conclusion

A majority of dental patients have good knowledge and attitude related to COVID-19. Predictors of good knowledge were sex, education level, marital status, and income of the participants. Sex predicted good attitude and age predicted good practice.

What Contributes to COVID-19 Vaccine Hesitancy? A Systematic Review of the Psychological Factors Associated with COVID-19 Vaccine Hesitancy

Vaccine hesitancy plays a crucial role in worldwide pandemic-control efforts. The multifaceted nature of vaccine hesitancy entails many psychological factors that are widely discussed in the literature, although few studies specifically compile these factors. Thus, this systematic review aims to synthesize the psychological factors contributing to vaccine hesitancy. As per the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, a systematic search was conducted on electronic databases PubMed, Scopus, Science Direct, PsycNET, and Web of Science, and a manual search was conducted on Google Scholar. Out of the 2289 articles obtained, 79 studies that met the inclusion criteria were deemed eligible for the review. The findings highlight appraisals of the COVID-19 pandemic, vaccine safety and side effects, vaccine confidence/trust, trust in government and healthcare professionals, scepticism around vaccine production, conspiracy beliefs, emotions, and information and knowledge about the vaccine as the major psychological factors contributing to vaccine hesitancy. Concerningly, misinformation on COVID-19 vaccination spread through social media platforms, increasing vaccine hesitancy. Recommendations for government authorities, healthcare professionals, and implications for future research are also outlined.

COVID-19 Vaccine Attitudes and Barriers among Unvaccinated Residents in Rural Northern/Central Illinois

Background

Rural communities have lower COVID-19 vaccine uptake and poorer health outcomes compared to non-rural communities, including in rural, northern/central Illinois. Understanding community perceptions about vaccination is critical for developing targeted responses to improve vaccine uptake in rural communities and meet global vaccination targets.

Purpose

This study examines COVID-19 vaccine attitudes and barriers as well as the impact of COVID-19 on specific health behaviors of residents in rural northern/central Illinois to inform efforts to increase vaccine uptake.

Methods

In collaboration with community partners and local health departments, we conducted a 54-item, English-language, online questionnaire from Feb 11 to March 22, 2021; the questionnaire included the COVID behavioral questionnaire scale (CoBQ), as well as questions on intention to vaccinate, vaccination attitudes, and barriers to vaccine access. Descriptive and bivariate analyses assessed participant differences based on intention to vaccinate.

Results

Most unvaccinated survey respondents (n = 121) were White (89.3%) and female (78.5%), with an average age of 52.3±14.1 years. Lack of intention to vaccinate was negatively associated with trust in the science behind vaccine development (P = .040), belief in the safety of the vaccine (P = .005) and belief that the vaccine was needed (P=.050). CoBQ scores of respondents who intended to get vaccinated differed significantly from those who did not (P<.001), showing a greater negative impact of COVID-19 on engaging in health behaviors for vaccine-hesitant participants.

Conclusion

Study findings show mistrust of science and lack of confidence in vaccine safety are barriers to vaccination in rural northern Illinois residents. Similar results have been reported in low- and middle-income countries.

COVID-19 vaccine hesitancy: A narrative review of four South Asian countries

Objectives

Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there's an interplay of financial and non-financial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers.

Methods

A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: "Afghanistan" OR "Pakistan" OR "India" OR "Bangladesh" in combination with "COVID-19 vaccine" and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper.

Results

A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223-5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy.

Conclusion

Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it difficult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.

Vaccine Acceptance and Hesitancy among Hospitalized COVID-19 Patients in Punjab, Pakistan

Vaccine hesitancy is widespread in many parts of the globe, particularly in low–middle-income countries. Therefore, we surveyed a sample of hospitalized COVID-19 patients to assess COVID-19 vaccine acceptance and vaccine hesitancy in a low–middle-income country. A cross-sectional sample of 385 confirmed reverse transcriptase–polymerase chain reaction COVID-19 patients treated at secondary and tertiary care hospitals in Punjab, Pakistan, were analyzed to assess COVID-19 vaccine uptake and vaccine hesitancy. The construct validity and reliability of the 11-item vaccine hesitancy questionnaire were also examined. In addition, multivariate logistic regression was used. The majority of the COVID-19 patients admitted to hospitals were not vaccinated (84%). Of those who were willing to receive vaccination, the majority (55%) considered vaccines an effective way to protect people from COVID-19. However, those who were not willing to receive their COVID-19 vaccine had significantly higher hesitancy than those willing to receive their COVID-19 vaccine. In addition, older hospitalized COVID-19 patients aged 60 years or above (20–29 years: OR 0.10; 95% CI 0.01–0.72, p = 0.001) and patients from urban areas (OR 3.16 95% CI 1.27–7.87, p = 0.013) were more likely to receive the COVID-19 vaccine than younger patients and patients from rural areas. Patients with no formal education had significantly higher hesitancy (OR 5.26; 96% CI 1.85–14.97, p = 0.002) than participants with graduation and above education. More than half of the study’s participants did not trust information shared on social media about COVID-19 vaccines and cited newspapers/news channels as their main source of information. The study provides important insights into COVID-19 vaccine acceptance and the impact of vaccination campaigns. Many unvaccinated COVID-19 patients in hospitals highlight the need for an effective vaccination drive to protect people from acquiring infection and subsequent hospitalization.

Perception towards vaccine effectiveness in controlling COVID-19 spread in rural and urban communities: A global survey

Introduction

Several studies exhibited varying reports of perception toward vaccine effectiveness, vaccine hesitancy, and acceptance of COVID-19 vaccines. As this fluctuated with evidence generation, this study explored the perception toward vaccine effectiveness in rural and urban communities among various countries.

Methods

A cross-sectional study was conducted online from April to August 2021 using convenience sampling among people from different countries approved by the Asia Metropolitan University Medical Research and Ethics. We adapted the questionnaire from the World Health Organization's (WHO) survey tool and guidance on COVID-19. The logistic regression models were performed to show perception toward vaccine effectiveness.

Results

A total of 5,673 participants responded to the online survey. Overall, 64% of participants agreed that the vaccine effectively controlled viral spread, and 23% agreed that there was no need for vaccination if others were vaccinated. Males had 14% higher odds of believing that there was no need for vaccination. Less social media users had 39% higher odds of developing the belief that there is no need for vaccination than all other people vaccinated.

Conclusion

People's perceptions toward vaccine acceptance have fluctuated with the information flow in various social media and the severity of COVID-19 cases. Therefore, it is important that the current scenario of peoples' perception toward vaccine acceptance and determinants affecting the acceptance are explored to promote the vaccination approach against COVID-19 prevention and transmission effectively.

Factors associated with COVID-19 vaccine hesitancy: a community-based household survey in Pune district of Maharashtra, India

Background

In the wake of the coronavirus (COVID-19) pandemic, the development of the COVID-19 vaccine became a game-changing tool. However, the rapid development of the COVID-19 vaccine gave rise to various myths, misconceptions and hesitancies among people.

Methods

A community-based household survey was conducted by the trained healthcare workers, i.e., Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) in their respective villages. Information on socio-demographic profile, vaccination status and reasons for vaccine hesitancy in community members was collected during the survey. Details of the vaccination status of community members were cross-examined with government vaccination data. After survey administration, continuous sensitisation to every individual was carried out by trained healthcare workers making people aware and motivating them to vaccinate. Healthcare workers constantly followed up on individuals showcasing hesitancy, thereby building up vaccine confidence in them.

Results

Out of the total study population (N=12,812), 90.1% were found eligible for COVID-19 vaccination (>18 years), 57.8% individuals had received both doses of COVID-19 vaccine, and 23.2% had received only the first dose (partially vaccinated), whereas 9.1% were unvaccinated. The most reported vaccine hesitancy response was being worried about vaccine side effects at 9.2%. The other set of reasons reported among aged 60 years and above were being old (1.6%) and having a co-morbid condition (1.1%). Having an underlying illness was also reported in both age groups (45-60 years, and 60 years and older). Additionally, 18.2% of the unvaccinated and partially vaccinated eligible individuals reported planning to get vaccinated soon.

Conclusions

The study reported many myths and misconceptions, and hesitancies related to the COVID-19 vaccine among the community members being a major lag in the vaccine acceptance and uptake. Therefore, adequate vaccine education is much needed to engage the non-medical group, as they mostly tend to have positive interactions with the community members. On that account, sustained community-based health promotion intervention can be effective.

COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region

Background

Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19.

Objectives

To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region.

Method

An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and August 2021.

Results

Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would increase if given adequate information and if their doctor recommended it.

Conclusion

Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.

Coverage of Coronavirus Disease-2019 (COVID-19) Booster Dose (Precautionary) in the Adult Population: An Online Survey

Background

The coronavirus disease-2019 (COVID-19) pandemic devastated public health worldwide, including India. COVID-19 vaccines and their boosters are life-saving developments that have helped prevent and control the spread of COVID-19. We conducted this study to assess the coverage of the booster dose in an Indian population (the third dose of the COVID-19 vaccine in India is referred to as the booster or precautionary dose), record the reasons for not taking the booster dose, and determine the effectiveness of the booster. The levels of adherence to COVID-19 precautionary behavior was also assessed. 

Methods

We conducted a descriptive, cross-sectional study using convenient sampling via an online survey of 550 respondents older than 18 in the second quarter of 2022. The respondents were distributed among 18 states and union territories in India. The data were analyzed as simple proportions and percentages.

Results

Of the 550 respondents, 152 (27.6%) received the booster dose, indicating low coverage. A small percentage of respondents (7.2%) reported suffering from COVID-19 following the booster, of whom 91% were medical professionals. The most common reported reason for not taking the vaccine was that the respondents were not yet due for their dose (48.1%). The time between the second dose of the COVID-19 vaccine and the booster had no impact on infection rates. Men were less likely to adhere to COVID-19 precautionary behavior than women, despite similar vaccination rates.

Conclusion

The COVID-19 vaccine booster had a low acceptance in our study population, with roughly one-quarter of the population receiving the booster. The booster dose has been influential in the prevention of COVID-19. Most respondents followed behavioral safety measures despite the decline of active cases of COVID-19 in India following the Omicron wave. Our results indicate a need to strengthen public strategies to affect behavioral changes, such as improving India's Behavior Change Communication program to ensure adequate booster dose coverage.