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Chen G, Yao Y, Zhang Y, Zhao F. The impact of risk perception and institutional trust on COVID-19 vaccine hesitancy in China. Hum Vaccin Immunother 2024; 20:2301793. [PMID: 38282324 PMCID: PMC10826627 DOI: 10.1080/21645515.2024.2301793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024] Open
Abstract
Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.
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Affiliation(s)
- Guiwu Chen
- Department of Public Administration, School of Public Administration and Emergency Mangement, Jinan University, Guangzhou, Guangdong, China
| | - Yiyun Yao
- Department of Public Administration, School of Public Administration and Emergency Mangement, Jinan University, Guangzhou, Guangdong, China
| | - Yaowen Zhang
- The Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Master of Public Administration Education Center, School of Public Administration and Emergency Mangement, Jinan University, Guangzhou, Guangdong, China
| | - Fei Zhao
- The Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Master of Public Administration Education Center, School of Public Administration and Emergency Mangement, Jinan University, Guangzhou, Guangdong, China
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2
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Zhou H, Zhao W, Ma R, Zheng Y, Guo Y, Wei L, Wang M. Mixed methods examination of risk perception on vaccination intentions: The perspective of doctor-patient communication. Vaccine 2024; 42:4072-4080. [PMID: 38782664 DOI: 10.1016/j.vaccine.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/17/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
AIM From the perspective of doctor-patient communication, this research used multiple methods combined natural language processing (NLP), a cross-sectional survey and an online experiment to investigated how risk perception influenced people's vaccination intention. METHODS In Study 1, we used Python to crawl 335,045 comments about COVID-19 vaccine published in a social media platform Sina Weibo (equivalent of Twitter in China) from 31 December 2020 to 31 December 2021. Text analysis and sentiment analysis was used to examine how vaccination intention, as measured by linguistic features from the LIWC dictionary, changed with individuals' perceptions of pandemic risk. In Study 2, we adopted a cross-sectional questionnaire survey to further test the relation of risk perception, vaccination intention, trust in physicians, and perceived medical recommendations in a Chinese sample (n = 386). In Study 3, we conducted an online experiment where we recruited 127 participants with high trust in physicians and 127 participants with low trust, and subsequently randomly allocated them into one of three conditions: control, rational recommendation, or perceptual recommendation. RESULTS Text and sentiment analysis revealed that the use of negative words towards COVID-19 vaccine had a significant decrease at high (vs. low) risk perception level time (Study 1). Trust in physicians mediated the effect of risk perception on vaccination intention and this effect was reinforced for participants with low (vs. high) level of perceived medical recommendation (Study 2), especially for the rational (vs. perceptual) recommendation condition (Study 3). CONCLUSION Risk perception increased vaccination intention through the mediating effect of trust in physicians and the moderating effect of perceived medical recommendations. Rational (vs. perceptual) recommendation is more effective in increasing intention to get vaccinated in people with low trust in physicians.
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Affiliation(s)
- Haichun Zhou
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China.
| | - Wenli Zhao
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China.
| | - Rong Ma
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China
| | - Yishu Zheng
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China.
| | - Yuxuan Guo
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China
| | - Liangyu Wei
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China
| | - Mingyi Wang
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, 35 Qinghua East Road, Beijing 100083, China.
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3
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Al Zahrani EM. The Role of Healthcare Leaders in Promoting Vaccine Acceptance in Saudi Arabia. J Healthc Leadersh 2024; 16:279-286. [PMID: 39072262 PMCID: PMC11277817 DOI: 10.2147/jhl.s470522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
Background Several vaccines have been recommended by the health authorities in recent years and have been opposed by debates, lack of public trust, and variable levels of hesitance that resulted in increased anti-vaccination advocacy and a subsequent reduction in vaccination rates worldwide. Purpose This study aimed to explore the community's perceptions of the role of healthcare leadership in promoting vaccine acceptance. Methods This cross-sectional study used a validated questionnaire designed according to the study's objectives for a heterogeneous purposive sample of individuals over 18 years old in Saudi Arabia. Participants completed the questionnaire online via a link provided by multiple social media platforms. Results The study included 7159 participants with various demographical features. On a five-point Likert scale, the average level of agreement on the role of healthcare executives in promoting vaccines was 3.76. The average level of agreement about the role of healthcare leaders in promoting vaccines was 3.76 out of five. Men were more likely than women to agree on healthcare worker's influence, 63.6% and 58.6%, respectively (P < 0.001). The ages of participants showed a favorable correlation with their level of agreement on the role of healthcare leaders in promoting vaccines (P < 0.001). The level of agreement on healthcare leader's role in promoting vaccines was inversely proportional to the education level (P < 0.001). The retired group reported the highest score, followed by the employed ones (P < 0.001). Conclusion Unlike other political and religious leaders, this study indicates that healthcare professionals significantly impact vaccine hesitancy and uptake. Despite rising vaccine hesitancy, healthcare leaders remain more trustworthy providers of guidance and influence over vaccination decisions than others. In addition, the health leader's factual message boosts people's self-esteem and helps them decide to be vaccinated.
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Affiliation(s)
- Eidan M Al Zahrani
- Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
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Murali A, Sojati J, Levochkina M, Pressimone C, Griffith K, Fan E, Dakroub A. A Cross-Sectional Analysis of Community Perceptions of Flu and COVID-19 Vaccines at Turtle Creek Primary Care Center. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:439-451. [PMID: 37837451 DOI: 10.1177/2752535x231205665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature. OBJECTIVE The objective of this mixed-methods study was to elucidate attitudes of patients at the Turtle Creek Primary Care Center, a clinic that cares for ∼70% non-white patients, towards flu and COVID-19 vaccines, with the goal of establishing vaccine education gaps and increasing vaccine uptake in minority communities. DESIGN/PATIENTS This study was conducted as a cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek clinic inquiring about flu and COVID-19 infection status and vaccination uptake (August 26-October 10, 2021). APPROACH/KEY RESULTS We found that rates of vaccination were subpar in the Turtle Creek community, with only 54% having received the COVID-19 vaccine and only 44% receiving the flu vaccine regularly. There was a strong association between COVID-19 and flu vaccine acceptance and a notable correlation between vaccine acceptance and age. When assessing how vaccine acceptance was influenced by trusted sources of information, those who cited trusting "medical professionals" and "word of mouth" had higher odds of COVID-19 vaccine acceptance but those who cited trusting "social media" had decreased odds of acceptance. Finally, we uncovered 14 common factors for either vaccine acceptance or refusal that clustered into four overarching themes of trust, need, safety, and availability. CONCLUSION These data highlight the necessity of improved vaccine education and reveal targetable populations and approaches for disseminating vaccine information.
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Affiliation(s)
- Anjana Murali
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jorna Sojati
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marina Levochkina
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kobi Griffith
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Fan
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allie Dakroub
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Bahri AA, Jareebi MA, Ryani MA, Othman JA, Mohrag M, Akish EA, Shami MO, Alessa HA, Madkhali JY, Bakri K, Hakami A, Otayn HA, Shok AA. Exploring COVID-19 Vaccine Intentions, Perceptions, and Uptake Among the Saudi Population. Cureus 2024; 16:e63404. [PMID: 39070374 PMCID: PMC11283866 DOI: 10.7759/cureus.63404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Background The widespread hesitancy, delays in acceptance, or outright refusal to receive vaccinations, even when readily available, present a notable global challenge. This is particularly pertinent in the context of COVID-19 vaccine hesitancy, where research shows considerable variability in hesitancy rates worldwide. The primary aim of this study is to investigate COVID-19 vaccine intentions among the Saudi population using behavioral theories as a framework. Methodology A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia from January 2022 to December 2022. An online self-administered survey was distributed via social media to reach the targeted participants. Both men and women aged >18 years were included, while non-Saudi individuals and people who are less than 18 years old were excluded. A total of 1,139 participants were included. Results The study found that about 96% of respondents were willing to receive a COVID-19 vaccination. Analyzing sociodemographic and COVID-19-related factors with vaccine intention showed that those previously diagnosed with COVID-19 were less likely to refuse vaccination (P = 0.015). Univariate analyses revealed significant differences in the health belief model (HBM) and theory of planned behavior (TPB) dimensions between willing and unwilling participants. Willing individuals perceived greater infection severity (P = 0.543), higher vaccination benefits (P < 0.01), fewer barriers (P < 0.01), more cues to action (P < 0.01), and lower infection prevention self-efficacy (P < 0.01) compared to the unwilling group. TPB dimensions also differed, with willing individuals having more favorable vaccine attitudes (P < 0.01) and stronger vaccination social norms (P < 0.01). A multivariate logistic regression indicated that having COVID-19 increased vaccine willingness likelihood (odds ratio [OR] = 2.11, 95% confidence interval [CI] 1.14-3.91). Perceived barriers (OR = 0.61, 95% CI 0.44-0.85), self-efficacy (OR = 1.96, 95% CI 1.16-3.32) from HBM, and favorable vaccine attitudes (OR = 1.55, 95% CI 1.02-2.35) from TPB were significant predictors of vaccine willingness. Conclusions The TPB highlighted the importance of attitudes and perceived norms in vaccination acceptance, suggesting their value in vaccination promotion strategies. However, further research, including prospective and interventional studies drawing from a wider array of psychological theories, is needed to develop effective interventions for promoting vaccination.
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Affiliation(s)
- Ahmed A Bahri
- Department of Community and Family Medicine, Jazan University, Jazan, SAU
| | - Mohammad A Jareebi
- Department of Community and Family Medicine, Jazan University, Jazan, SAU
| | - Majed A Ryani
- Department of Community and Family Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Jamaludeen A Othman
- Department of Anesthesia and Critical Care, Jazan University Hospital, Jazan, SAU
| | - Mostafa Mohrag
- Department of Internal Medicine, Jazan University, Jazan, SAU
| | - Eyas A Akish
- Department of Medicine, Jazan University, Jazan, SAU
| | | | - Hanan A Alessa
- Department of Family Medicine, Health Affairs in Jazan Region, Jazan, SAU
| | - Jalal Y Madkhali
- Department of Family Medicine, Health Affairs in Jazan Region, Jazan, SAU
| | - Khalid Bakri
- Department of Medicine and Surgery, Jazan University, Jazan, SAU
| | | | - Hamad A Otayn
- Department of Family Medicine, Health Affairs in Jazan Region, Jazan, SAU
| | - Ahmad A Shok
- Department of Pediatric Medicine, Health Affairs in Jazan Region, Jazan, SAU
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Vashist K, Yankey D, Elam-Evans LD, Mu Y, Valier MR, Pingali C, Hill HA, Santibanez TA, Singleton JA. Changes in vaccine hesitancy among parents of children aged 6 months - 17 Years, National Immunization Surveys, 2019-2022. Vaccine 2024:S0264-410X(24)00596-6. [PMID: 38806351 DOI: 10.1016/j.vaccine.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States. METHODS Data from the 2019-2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months -17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5-11 years, and 12-17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points- before and after the authorization of the COVID-19 vaccine for each age group. RESULTS Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: -3.9, -0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5-11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12-17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups. DISCUSSION About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5-11 years and declined for children aged 6 months-4 years.
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Affiliation(s)
- Kushagra Vashist
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Yi Mu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Madeleine R Valier
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Cassandra Pingali
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Holly A Hill
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tammy A Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Rahayuningsih N, Sinuraya RK, Fatinah Y, Diantini A, Suwantika AA. Impact of COVID-19 Pandemic on Routine Childhood Immunization Programs in Indonesia: Taking Rural and Urban Area into Account. Patient Prefer Adherence 2024; 18:667-675. [PMID: 38505189 PMCID: PMC10949301 DOI: 10.2147/ppa.s448901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
Background To date, the primary global concern has revolved around addressing the COVID-19 pandemic. However, there is a growing awareness of the pandemic's secondary impacts on critical aspects of healthcare, such as childhood immunization programs. Objective This study aims to assess the impact of the COVID-19 pandemic on childhood immunization programs in Indonesia, with a specific focus on performance disparities between rural and urban areas. It considers factors like access, utilization, and program workload. Methods Data were collected from primary health cares (PHCs) in two regions in West Java Province, Indonesia, representing rural and urban areas. A descriptive analysis was conducted to compare vaccination coverage, drop-out rates, and the ratio of vaccinators per dose from 2019 to 2021 in 40 and 22 PHCs for rural and urban areas, respectively. A general linear model was employed to evaluate the differences in these parameters over the three consecutive years. Results The results indicate fluctuations in vaccine coverage over the three years, with the most significant impact observed in 2020, particularly in rural areas. Statistical analysis revealed a significant difference in routine immunization coverage, drop-out rates, and vaccinator ratios between rural and urban areas from 2019 to 2021 (p<0.05). In 2021, both rural and urban areas displayed significant differences in performance parameters for routine immunization and COVID-19 vaccination (p<0.05), except in terms of coverage for IPV and COVID-19 vaccination. Conclusion The study highlights a reduction in routine immunization coverage during the pandemic, a concerning issue that increases the risk of vaccine-preventable diseases, particularly in rural areas.
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Affiliation(s)
- Nur Rahayuningsih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Faculty of Pharmacy, Universitas Bakti Tunas Husada, Tasikmalaya, Indonesia
| | - Rano K Sinuraya
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Yasmin Fatinah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Sumedang, Indonesia
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Rosen B, Hartal M, Waitzberg R. The Israeli health system's rapid responses during the COVID-19 pandemic. Isr J Health Policy Res 2024; 13:11. [PMID: 38438926 PMCID: PMC10910866 DOI: 10.1186/s13584-024-00596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic posed numerous challenges to health systems around the world. In addressing many of those challenges, Israel responded quite rapidly. While quick action is not an end in it itself, it can be important in responding to disease outbreaks. Some of Israel's rapid responses to the pandemic contributed significantly to population health and provided important learning opportunities for other countries. MAIN BODY Some of the most prominent Israeli rapid responses were related to vaccination. Israel led the world in the pace of its initial vaccine rollout, and it was also the first country to approve and administer booster vaccines to broad segments of the population. In addition, Israeli scholars published a series of timely reports analyzing vaccination impact, which informed policy in Israel and other countries. Israel was a rapid responder in additional areas of public health. These include the partial closure of its borders, the adoption of physical distancing measures, the use of digital surveillance technology for contact tracing, the use of wastewater surveillance to monitor viral spread, and the use of vaccine certificates ("green passes") to facilitate a return to routine in the face of the ongoing pandemic. Many factors contributed to Israel's capacity to repeatedly respond rapidly to a broad array of COVID-19 challenges. These include a national health insurance system that promotes public-private coordination, a system of universal electronic health records, a high level of emergency preparedness, a culture of focusing on goal attainment, a culture of innovation, and the presence of a strong scientific community which is highly connected internationally. In addition, some of the rapid responses (e.g., the rapid initial vaccination rollout) facilitated rapid responses in related areas (e.g., the analysis of vaccination impact, the administration of boosters, and the adoption of green passes). While rapid response can contribute to population health and economic resilience, it can also entail costs, risks, and limitations. These include making decisions and acting before all the relevant information is available; deciding without sufficient consideration of the full range of possible effects, costs, and benefits; not providing enough opportunities for the involvement of relevant groups in the decision-making process; and depleting non-renewable resources. CONCLUSIONS Based on our findings, we encourage leaders in the Israeli government to ensure that its emergency response system will continue to have the capacity to respond rapidly to large-scale challenges, whether of a military or civilian nature. At the same time, the emergency response systems should develop mechanisms to include more stakeholders in the fast-paced decision-making process and should improve communication with the public. In addition, they should put into place mechanisms for timely reconsideration, adjustment, and-when warranted-reversal of decisions which, while reasonable when reached, turn out to have been ill-advised in the light of subsequent developments and evidence. These mechanisms could potentially involve any or all branches of government, as well as the public, the press, and professional organizations. Our findings also have implications for health system leaders in other countries. The Israeli experience can help them identify key capacities to develop during non-emergency periods, thus positioning themselves to respond more rapidly in an emergency. Finally, health system leaders in other countries could monitor Israel's rapid responses to future global health emergencies and adopt selected actions in their own countries.
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Affiliation(s)
- Bruce Rosen
- Myers-JDC-Brookdale Institute, JDC Hill, PO Box 3886, 91037, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Hartal
- Myers-JDC-Brookdale Institute, JDC Hill, PO Box 3886, 91037, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Waitzberg
- Myers-JDC-Brookdale Institute, JDC Hill, PO Box 3886, 91037, Jerusalem, Israel.
- Technische Universität Berlin, Berlin, Germany.
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Shapiro Ben David S, Baruch Gez S, Adler L, Kovatch R, Rahamim-Cohen D, Shamir-Stein N, Shahar A, Mizrhi-Reuveni M. Short term safety of BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine among children aged 5-11 years, a nationwide parental survey. Vaccine 2024; 42:1154-1159. [PMID: 38281902 DOI: 10.1016/j.vaccine.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/03/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE SARS-CoV-2 vaccine safety is of major interest worldwide, and transparent information about potential side effects is essential to decrease vaccine hesitancy. The aim of this study was to assess SARS-CoV-2 BNT162b2 vaccine short-term side effects among children aged 5-11 years. METHODS An observational, cross sectional study of vaccine side-effects using electronic surveys sent to parents one week post administration of BNT162b2 vaccine to their child in a large health maintenance organization in Israel. RESULTS First dose and second dose surveys were filled for 5,842 and 6,126 children, respectively, with a response rate of 32.1% and 24.8%. Local side effects were reported by 68.7% and 69.1% of the first and second survey respondents, and general side effects were reported by 20.8% and 34.5% of them. The symptoms most frequently reported were fatigue, headache and myalgia. Duration of symptoms lasted three days or less among 86.5% and 81.5% of first and second dose survey respondents. Most respondents (92%) reported that their child did not need any medical consultation following vaccination. CONCLUSIONS We found further support for the BNT162b2 SARS-CoV-2 vaccine short- term safety among children aged 5-11 years. With ongoing pandemic and future booster COVID-19 vaccines, these findings can encourage vaccine confidence for parents and providers.
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Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel; Tel Aviv University School of Medicine, Tel Aviv, Israel.
| | | | - Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel; Tel Aviv University School of Medicine, Tel Aviv, Israel
| | - Rada Kovatch
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | | | - Arnon Shahar
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
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10
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Benson BR, Rahman SA, Bleasdale J, Win S, Townsend-Kensinger K, Cole M, Jalal K, Yu J, Morse GD, Mohler JL, Ward RL. Trusted Information Sources About the COVID-19 Vaccine Vary in Underserved Communities. J Community Health 2024:10.1007/s10900-023-01319-0. [PMID: 38300477 DOI: 10.1007/s10900-023-01319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
The COVID-19 pandemic was one of the deadliest global public health events. In the United States, over 1.1 million individuals have died, and now COVID-19 is the third leading cause of death (CDC, 2023). Vaccine uptake has stalled among different demographics. Vaccine hesitancy, a delay in accepting or refusing vaccines, poses a significant challenge regardless of the availability of safe and effective COVID-19 vaccines. This study aimed to identify disparate COVID-19 vaccine uptake among individuals in Western New York. The primary objective was to identify the factors contributing to lower rates of COVID-19 vaccination within this population.Data were collected from 585 adults recruited from 20 Niagara and Erie Counties sites using a self-administered survey on vaccine hesitancy, vaccination status, and COVID-19-related characteristics. The survey included the adult Vaccine Hesitancy Scale (aVHS) and acquired information on demographic characteristics and COVID-19 impact, knowledge, and information sources. Data were analyzed using descriptive statistics, a chi-squared test, a Wilcoxon rank-sum test, and a logistic regression model.Findings suggest that unvaccinated participants (n = 35) were concerned about vaccine side effects (48.6%). For vaccinated/unboosted participants (n = 52), they (40.0%) reported clinical concerns. After adjusting for gender and age, healthcare provider guidance and family guidance remained significant predictors of vaccination status, while clinical research studies were significant predictors of booster status. Findings from this study suggest public health interventions that target vaccine education and facilitate well-informed decisions about COVID-19 vaccines lead to less vaccine hesitancy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - James L Mohler
- Roswell Park Comprehensive Cancer Center (Urology, Pharmacology and Therapeutics), Buffalo, NY, USA
| | - Rolanda L Ward
- Department of Social Work, Niagara University, Niagara Falls, NY, USA.
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Jiang W, Lu C, Yan X, Tucker JD, Lin L, Li J, Larson HJ, Gong W, Wu D. Vaccine confidence mediates the association between a pro-social pay-it-forward intervention and improved influenza vaccine uptake in China: A mediation analysis. Vaccine 2024; 42:362-368. [PMID: 38103961 PMCID: PMC10789265 DOI: 10.1016/j.vaccine.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION A Chinese clinical trial has demonstrated that a prosocial pay-it-forward intervention that offered subsidized vaccination and postcard messages effectively increased influenza vaccine uptake and vaccine confidence. This secondary analysis explored the potential mediating role of vaccine confidence on the association between a pay-it-forward intervention and influenza vaccine uptake, and how this might vary by individual annual income levels. METHODS Data from 300 participants (150 standard-of-care and 150 pay-it-forward participants) were included in the analysis. We conducted descriptive analysis of demographic and vaccine confidence variables. Multivariable regression and mediation analysis on interventions, vaccine confidence and vaccine uptake were conducted. A sub-group analysis was conducted to further understand whether associations between these variables vary by income levels (<=$1860 or >$1860). RESULTS The pay-it-forward intervention was significantly associated with greater levels of perceived influenza vaccine importance (adjusted odds ratio (aOR) = 3.60, 95 %CI: 1.77-7.32), effectiveness (aOR = 3.37, 95 %CI: 1.75-6.52) and safety (aOR = 2.20, 95 %CI: 1.17-4.15). Greater perceived influenza vaccine importance was associated with increased vaccine uptake (aOR = 8.51, 95 %CI: 3.04-23.86). The indirect effect of the pay-it-forward intervention on vaccination was significant through improved perceived influenza vaccine importance (indirect effect1 = 0.07, 95 %CI: 0.02-0.11). This study further revealed that, irrespective of the individual income level, the pay-it-forward intervention was associated with increased vaccine uptake when compared to the standard-of-care approach. CONCLUSIONS Pay-it-forward intervention may be a promising strategy to improve influenza vaccine uptake. Perceived confidence in vaccine importance appears to be a potential mediator of the association between pay-it-forward and vaccine uptake.
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Affiliation(s)
- Wenwen Jiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Health of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunlei Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Health of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xumeng Yan
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Joseph D Tucker
- SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Room 360, Keppel St, London WC1E 7HT, UK
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Jing Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Wenfeng Gong
- China Country Office of the Bill and Melinda Gates Foundation, China
| | - Dan Wu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Room 360, Keppel St, London WC1E 7HT, UK; Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, Nanjing, Jiangsu, China.
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12
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Butt IN, van Eeden C, Kovacs Burns K, Saxinger L, Clifford A, Redmond D, Cohen Tervaert JW, Yacyshyn E. Understanding COVID-19 vaccine hesitancy in vasculitis patients. Front Public Health 2023; 11:1301492. [PMID: 38111485 PMCID: PMC10726054 DOI: 10.3389/fpubh.2023.1301492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Objective To identify the factors that impact COVID-19 vaccine decision-making in vaccine-hesitant vasculitis patients, and compare their perceptions with other rheumatology patients, given existence of data suggesting rheumatology patients may have disease-specific factors that influence their COVID-19 vaccine decision-making. Methods This cross-sectional study surveyed adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic, in Canada, between June and August 2021, using an anonymous online questionnaire. Survey responses were analyzed for statistical differences using chi-square analysis. Results The COVID-19 Vaccine Perceptions Survey had a response rate of 70.9%. Of the total 231 respondents, 103 patients were diagnosed with vasculitis. At the time of the survey, 10.6% of vasculitis patients refused to receive a COVID-19 vaccine compared to 6.3% for other rheumatology patients. Compared to other rheumatology patients, vaccine-hesitant vasculitis patients were significantly more concerned about almost every aspect of available COVID-19 vaccines [e.g., safety (p < 0.001), components (p < 0.001)], and feared that they could contract SARS-CoV-2 from a vaccine (p < 0.001). These vaccine-hesitant patients were also significantly less pleased with the government's pandemic response, less confident in healthcare team-provided information (p < 0.001), and more likely to report that healthcare providers had no role in their COVID-19 vaccine decision-making (p < 0.001). Conclusion Vaccine-hesitant vasculitis patients may have multiple considerations influencing COVID-19 vaccine hesitancy, including vaccine and disease-specific concerns, along with unfavorable perceptions of the healthcare system (government and healthcare providers). Healthcare providers can address some of these concerns by initiating patient-centered discussions around immunizations to help support educated decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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13
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Ledda C, Motta G, Rapisarda V, Maltezou HC. Influenza immunization of healthcare personnel in the post-COVID-19 pandemic era: Still a lot to do! Vaccine X 2023; 15:100402. [PMID: 38058792 PMCID: PMC10696103 DOI: 10.1016/j.jvacx.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
Healthcare-associated influenza is frequently encountered in healthcare settings with significant morbidity and mortality among vulnerable patients, absenteeism among healthcare personnel (HCP), and interruption of healthcare services. Numerous investigations indicate that nosocomial outbreaks are often traced to HCP. Despite the international and national endorsements, seasonal influenza vaccine acceptance among HCP continues suboptimal worldwide. Infection control is the major objective for healthcare risk management in order to guarantee patient safety, limit the cost of hospitalization and assurance health management in controlling influenza seasons. Vigilance and anticipation are required as globally we are moving from a reactive COVID-19 pandemic response phase to one of planning for the co-circulation of viral respiratory infections. Declining to understand HCP perception of influenza risk and acceptance of vaccination might have impact patient safety as well as healthcare services.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Motta
- Occupational Medicine Unit, “Garibaldi” Hospital of Catania, Catania, Italy
| | - Venerando Rapisarda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Occupational Medicine Unit, “G. Rodolico – San Marco” University Hospital, Catania, Italy
| | - Helena C. Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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14
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Afsharinia B, Gurtoo A. Role of leadership and incentive-based programs in addressing vaccine hesitancy in India. Vaccine X 2023; 15:100346. [PMID: 37577213 PMCID: PMC10413069 DOI: 10.1016/j.jvacx.2023.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
The current study goes beyond the popular 5Cs model of vaccine hesitancy to explore perceived social norms, role of leadership and the role of incentive-based intervention for improving the likelihood of vaccination, in a population-representative sample of adults in India (N = 1129). We investigated differences in socio-demographic status, perceived descriptive norms like vaccine behaviours, beliefs, experience and perceived injunctive norms like community and political leadership within the context of the COVID-19 pandemic are related to vaccination. Further, we examined the role of incentive-based intervention as a potentially salient predictor of adults' vaccine uptake. The study is based on a cross-sectional survey conducted in July-November 2021, which included questions about impacts of pandemic collected by phone call interview from adults' beneficiaries of Government free food schemes, across 11 states in India. The data include 81 % vaccinated and 19 % vaccine hesitant participants, with a higher proportion of business or self-employed (53.1 %) as vaccine hesitant. We performed the t-test to assess the variation between vaccinated and vaccine hesitant adults, and Exploratory Factor Analysis to uncover the underlying dimension of vaccine hesitancy. Subsequently, Binary Logistic Regression model probed the factors associated with likelihood of vaccination uptake. In contrast to the prevailing evidence, results demonstrated community and political leadership has significant negative impact on vaccination (p-value < 0.06, 95 % CI, 0.57-1.01). Incentive-based intervention offer a vital leverage to enhance positive attitude towards vaccination (p-value < 0.05, 95 % CI, 1.01-1.80). The results thus broadly highlight the limited role of political and community leaders in leveraging their influence on vaccination, the role of timely, accurate information, applications of telemedicine as an important tool to provide healthcare and the need for optimal design of incentive-based vaccination programs recommended by trusted sources.
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Affiliation(s)
- Bita Afsharinia
- Senior Research Scholar, Department of Management Studies, Indian Institute of Science, Bangalore 560012, India
| | - Anjula Gurtoo
- Senior Research Scholar, Department of Management Studies, Indian Institute of Science, Bangalore 560012, India
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15
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Maneesriwongul W, Deesamer S, Butsing N. Parental Vaccine Literacy: Attitudes towards the COVID-19 Vaccines and Intention to Vaccinate Their Children Aged 5-11 Years against COVID-19 in Thailand. Vaccines (Basel) 2023; 11:1804. [PMID: 38140208 PMCID: PMC10747165 DOI: 10.3390/vaccines11121804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND High rates of population immunity are needed to control the COVID-19 pandemic. This study aimed to assess parents' intention to have their children, aged 5-11 years, vaccinated against COVID-19 and its influencing factors in Thailand. METHODS A cross-sectional online survey was conducted before the nationwide COVID-19 vaccine rollout for children aged 5-11 years in Thailand. A sample of 542 parents with children in this age group was recruited online. RESULTS In total, 58.8% of parents intended to vaccinate their child against COVID-19. Logistic regression analysis revealed that influencing factors include child age, parents' education, interactive/critical vaccine literacy, attitudes that the COVID-19 vaccine is safe and effective for children, that the vaccine can reduce the severity of COVID-19 in children, that there were other ways to prevent children from contracting COVID-19 superior to vaccination, and that COVID-19 vaccination in children can be fatal. The main reasons for having an intention to vaccinate their children included to reduce the severity of symptoms if infected with COVID-19 and to protect them from contracting COVID-19 when they go to school. CONCLUSIONS Our study provides evidence regarding factors influencing parents' intention to vaccinate their children. The findings can be used to design future interventions to promote COVID-19 vaccine uptake in children.
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Affiliation(s)
| | - Suhong Deesamer
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.M.); (N.B.)
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16
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Guarducci G, Mereu G, Golinelli D, Galletti G, Gemmi F, Cartocci A, Holczer N, Bacci L, Sergi A, Messina G, Mari V, Nante N. Factors Influencing the Healthcare Workers' Willingness to Receive the COVID-19 Booster Dose in Tuscany (Italy). Vaccines (Basel) 2023; 11:1751. [PMID: 38140156 PMCID: PMC10748028 DOI: 10.3390/vaccines11121751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The World Health Organization has defined vaccine hesitancy as behavior influenced by several factors, including trust in the vaccine itself or its provider or the perceived need for vaccination. The aim of this study was to investigate the factors influencing the willingness to receive the COVID-19 vaccine among the employees and healthcare professionals of the Central Tuscany Local Health Authority (CT-LHA) in Italy. METHODS From July to October 2022, a cross-sectional study was conducted. An online questionnaire was administered to 7000 employees of the CT-LHA. The questionnaire analyzed the factors that influenced receiving the booster dose of the COVID-19 vaccine. The sample was stratified by gender, age, type of occupation (healthcare or non-healthcare workers), and seniority. Incomplete questionnaires were excluded. A chi-squared test was performed through STATA. The significance level was set at 95%. RESULTS Of the questionnaires administered, 1885 (26.9%) questionnaires were eligible for the study. In the previous vaccination campaign, the healthcare workers (HCWs) considered the vaccine used by CT-LHA as safe, in contrast to non-healthcare workers (N-HCWs), who considered it less secure (p < 0.05). The HCWs showed a higher propensity for vaccine safety to receive the booster dose than N-HCWs. N-HCWs appeared to be less affected by an updated booster dose than HCWs (p < 0.05). CONCLUSIONS The factors studied appear to influence HCWs differently from N-HCWs. Both HCWs and N-HCWs would choose an upgraded mRNA vaccine for the booster dose.
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Affiliation(s)
- Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (D.G.); (G.M.); (N.N.)
| | - Giovanna Mereu
- Department of Technical Health Professions, Central Tuscany Local Health Authority, 50121 Florence, Italy;
| | - Davide Golinelli
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (D.G.); (G.M.); (N.N.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Giacomo Galletti
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy; (G.G.); (F.G.)
| | - Fabrizio Gemmi
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy; (G.G.); (F.G.)
| | - Alessandra Cartocci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Nora Holczer
- General Direction, Central Tuscany Local Health Authority, 50121 Florence, Italy (V.M.)
| | - Luca Bacci
- Web Communication and Promotion, Central Tuscany Local Health Authority, 50121 Florence, Italy;
| | - Alessandro Sergi
- Healthcare Management, Central Tuscany Local Health Authority, 50121 Florence, Italy;
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (D.G.); (G.M.); (N.N.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Valerio Mari
- General Direction, Central Tuscany Local Health Authority, 50121 Florence, Italy (V.M.)
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (D.G.); (G.M.); (N.N.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
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Tippins E, Ysseldyk R, Peneycad C, Anisman H. Believing in science: Linking religious beliefs and identity with vaccination intentions and trust in science during the COVID-19 pandemic. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:1003-1020. [PMID: 37278005 PMCID: PMC10247686 DOI: 10.1177/09636625231174845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite evidence supporting numerous scientific issues (e.g. climate change, vaccinations) many people still doubt the legitimacy of science. Moreover, individuals may be prone to scepticism about scientific findings that misalign with their ideological beliefs and identities. This research investigated whether trust in science (as well as government and media) and COVID-19 vaccination intentions varied as a function of (non)religious group identity, religiosity, religion-science compatibility beliefs, and/or political orientation in two online studies (N = 565) with university students and a Canadian community sample between January and June 2021. In both studies, vaccination intentions and trust in science varied as a function of (non)religious group identity and beliefs. Vaccine hesitancy was further linked to religiosity through a lack of trust in science. Given the ideological divides that the pandemic has exacerbated, this research has implications for informing public health strategies for relaying scientific findings to the public and encouraging vaccine uptake in culturally appropriate ways.
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Vaux S, Gautier A, Nassany O, Bonmarin I. Vaccination acceptability in the French general population and related determinants, 2000-2021. Vaccine 2023; 41:6281-6290. [PMID: 37673718 DOI: 10.1016/j.vaccine.2023.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND This study describes the evolution of vaccination acceptability and associated determinants in the French general population between 2000 and 2021, and vaccinations with the highest vaccine hesitancy between 2010 and 2021. METHODS Data were collected from the nine national 'Health Barometer' cross-sectional surveys conducted between 2000 and 2021. These surveys included French-speaking individuals aged 18-75 years old who were selected through randomly generated landline and mobile phone numbers. Participants were asked about their acceptability of vaccination in general and their vaccine hesitancy toward any particular vaccinations. Determinants of vaccination acceptability were studied using univariate and multivariate Poisson regressions. RESULTS The proportion of persons who found vaccination acceptable in general (i.e., answering "very" or "somewhat" favourable in the survey interview) decreased from 91.1% in 2000 to 61.2% in 2010 (the latter year coinciding with the 2009 H1N1 influenza pandemic), increased in 2014 (78.8%), slightly fluctuated until 2019 (74.2%), and increased again in both 2020 (80.0%) and 2021 (82.5%) during the COVID-19 pandemic. Irrespective of the year, acceptability was higher among persons with higher incomes, those with a higher education level, and individuals not living alone. In 2021, for the first time, vaccination acceptability was higher among persons over 44 years old (versus 18-24 year-olds) and among retired persons (versus workers). The highest hesitancy rate for a vaccine was for the 2009 H1N1 influenza virus in 2010 (41% answering "somewhat" or "very" unfavourable). In 2021, the highest rate was for the COVID-19 vaccine (21%). DISCUSSION Unlike the experience of the 2009 AH1N1 influenza pandemic, which led to a collapse in vaccination acceptability among the French general population, acceptability continued to increase during the COVID-19 pandemic. However, the pre-2010 level was not reached. Our results show a tendency towards a widening social and economic gap in terms of vaccine acceptability over time.
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Affiliation(s)
- Sophie Vaux
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France.
| | - Arnaud Gautier
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
| | - Oriane Nassany
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
| | - Isabelle Bonmarin
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
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Milionis C, Ilias I, Tselebis A, Pachi A. Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1744. [PMID: 37893462 PMCID: PMC10608755 DOI: 10.3390/medicina59101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Athanasios Tselebis
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
| | - Argyro Pachi
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
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Anino CO, Wandera I, Masimba ZO, Kirui CK, Makero CS, Omari PK, Sanga P. Determinants of Covid-19 vaccine uptake among the elderly aged 58 years and above in Kericho County, Kenya: Institution based cross sectional survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001562. [PMID: 37698989 PMCID: PMC10497123 DOI: 10.1371/journal.pgph.0001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
Hesitancy to Covid-19 vaccine is a global challenge despite the compelling evidence of the value of vaccine in preventing disease and saving lives. It is suggested that context-specific strategies can enhance acceptability and decrease hesitancy to Covid-19 vaccine. Hence, the study determined uptake and determinants of Covid-19 vaccine following a sustained voluntary vaccination drive by Kenyan government. We conducted institution based cross-sectional survey of 1244 elderly persons aged 58 to 98 years in the months of January, February and March, 2022. A multinomial logistic regression analysis was used to investigate determinants of Covid 19 vaccine uptake. The predictor variables included socioeconomic and demographic characteristics, convenience and ease of access of the vaccine, collective responsibility, complacency and the three dimensions of confidence; trust in safety, trust in decision makers and delivery system. The findings are reported as the adjusted odd ratio (AOR) at 95% confidence interval (CI). Significant level was considered at p <0.05. The results from the multinomial logistic regression analysis indicated that advanced age and presence of chronic disease were associated with increased odds of doubt on Covid 19 vaccine, while long distance from vaccination centers was associated with increased odds of delay in vaccination. Overall, the findings of this study provided valuable insights into the factors influencing vaccine hesitancy among the elderly population in Kenya and will inform the development of targeted interventions to increase vaccine acceptance and uptake in this population.
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Batool R, Yousafzai MT, Qureshi S, Muhammad S, Qazi I, Sadaf T, Ashorn P, Qamar FN. Parental acceptance of typhoid conjugate vaccine for children aged 6 months to 15 years in an outbreak setting of Lyari Town Karachi, Pakistan. Vaccine 2023; 41:5376-5382. [PMID: 37463829 PMCID: PMC10448379 DOI: 10.1016/j.vaccine.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/18/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND This study aimed to evaluate the parental acceptance of Typhoid Conjugate Vaccine (TCV) and to determine the predictors of TCV vaccination status among children in an outbreak setting of extensively drug resistant (XDR) typhoid fever in Karachi, Pakistan. METHODS A cross-sectional survey using the WHO recommended rapid vaccine coverage assessment technique was conducted. Out of 11, four union councils (UCs) in Lyari Town were randomly selected. A parent or primary caretaker from the eligible household was interviewed. Data were collected using a locally validated vaccine attitudes scale (VAS). Sum of scores was calculated for VAS. A higher score denoted negative attitudes and perceptions regarding TCV and vice versa. Multivariable logistic regression was performed to determine the predictors of TCV vaccination status. RESULTS Based on the 14-item parental VAS, 78.0 % of the parents had a score between 0 to <40 and 22 % had a score ≥40. VAS score of <40 was significantly associated with higher odds of receiving TCV during the campaign setting (adjusted Odds Ratio (aOR): 1.30; 95 % Confidence Interval (CI): 1.02, 1.66). The odds of receiving TCV vaccination were higher among children whose parents were aware of the ongoing vaccination campaign in the area (aOR: 4.57; 95 % CI: 2.93, 7.12) and expressed willingness to get their child vaccinated against typhoid fever (aOR: 2.54; 95 % CI: 1.82, 3.55). CONCLUSION Parental awareness of the ongoing vaccination campaign, positive perception and attitudes towards vaccine were found to be significantly associated with TCV vaccination among children. Appropriately structured pre-vaccination awareness campaigns focused on childhood vaccination targeted towards parents are necessary to improve parental awareness, attitude and behavior towards vaccination.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan; The Kirby Institute, UNSW Sydney, Wallace Wurth Building High Street, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Sajid Muhammad
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Ibtisam Qazi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Per Ashorn
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan.
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Reyes CT, Cao W, Astorini AG, Drohan MM, Schulz CT, Shuster CL, Robbins ML, Yang M, Stamates AL. Using the theory of planned behavior to assess willingness and attitudes towards COVID-19 vaccination among a predominantly white U.S. college sample. Health Psychol Behav Med 2023; 11:2248236. [PMID: 37601893 PMCID: PMC10438853 DOI: 10.1080/21642850.2023.2248236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Through the lens of behavioral models such as the Theory of Planned Behavior (TPB) and the Health Belief Model, the present study (1) investigated U.S. university students' willingness to receive the COVID-19 vaccine and (2) examined predictors (e.g. demographics, past vaccine experience, TPB constructs) of vaccine willingness. Method University students (n = 170) completed a survey assessing demographics, health behaviors, attitudes, perceived severity/susceptibility, norms, and vaccine intentions related to the COVID-19 pandemic. Data were collected from April 2020 through July 2020. Results Overall, 56.5% of participants indicated that they would be willing to receive the COVID-19 vaccine once it is available, 39.4% were unsure of whether they would receive the vaccine, and 4.1% indicated they would not receive the vaccine. Multinomial logistic regression indicated that greater adherence to CDC guidelines (p = .030) and greater perceived pro-vaccine norms (p < .001) predicted greater vaccine willingness. Conclusions Results from this study are consistent with previous literature on vaccine hesitancy, whereby normative beliefs and adherence to CDC guidelines were found to be determinants of vaccine willingness. To reduce transmission of the COVID-19 pandemic, interventions aimed at promoting positive attitudes towards vaccination should aim to incorporate these observed determinants.
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Affiliation(s)
- Cheyenne T. Reyes
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Wenqiu Cao
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Megan M. Drohan
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Coral L. Shuster
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Mark L. Robbins
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Amy L. Stamates
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Licata F, Romeo M, Di Gennaro G, Citrino EA, Bianco A. Pertussis immunization during pregnancy: results of a cross-sectional study among Italian healthcare workers. Front Public Health 2023; 11:1214459. [PMID: 37483935 PMCID: PMC10359148 DOI: 10.3389/fpubh.2023.1214459] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background This study aimed to assess whether Italian healthcare workers (HCWs) recommend the reduced antigen content tetanus-diphtheria-acellular pertussis vaccination (Tdap) to pregnant people, as well as what variables could predict their decision to advise and recommend immunization to pregnant people. Methods This cross-sectional study took place between August 2021 and June 2022 in a sample of obstetricians-gynecologists, midwives, and primary-care physicians in two regions of Southern Italy. A self-administered questionnaire was used to gather the data. Results The results showed 91.3% (379) of participants knew that receiving the Tdap vaccine during pregnancy protects against pertussis in both the expectant person and the newborn before active immunization. Only 68.9% (286) knew that the Tdap vaccination has to be administered during the third trimester of gestation. A small but still significant proportion of participants (14.7%) (61) believed that the potential risks of vaccines administered during pregnancy outweighed the benefits. An improvable proportion of HCWs regularly provided information [71.8% (298)] and recommended [81% (336)] Tdap vaccination to pregnant people. The strongest factors that drove HCWs to inform pregnant people about the Tdap vaccination were to be aware that vaccinating those in close contact with newborns is an effective strategy to prevent pertussis (OR: 2.38; 95% CI: 1.11-5.13) and that the Tdap vaccine is provided only in the third trimester of pregnancy (OR: 1.74; 95% CI: 1.06-2.86). Informing pregnant people about the possibility of receiving the Tdap vaccine during pregnancy (OR: 60.13; 95% CI: 23.50-153.8) was the strongest predictor of having recommended the Tdap vaccination during pregnancy. Conclusion Educational and informative interventions to improve HCWs' knowledge about the importance of the Tdap vaccine and their communication skills to properly counsel pregnant people are needed. Beyond vaccine recommendations, how well immunization strategies are implemented in real-world situations impacts vaccination uptake. Therefore, during regular care visits, expecting people must have easy access to vaccines. Prenatal immunizations should become common practice, and there should be no conceptual doubt about vaccinations among HCWs to safeguard pregnant people and their unborn children from vaccine-preventable diseases.
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Affiliation(s)
| | | | | | | | - Aida Bianco
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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24
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Akbar MB, Singh L, Deshpande S, Amoncar N. COVID-19 vaccine perceptions among South Asian communities in the UK: An application of the theory of planned behavior. Health Mark Q 2023; 40:271-288. [PMID: 35787243 DOI: 10.1080/07359683.2022.2092325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Based on the Theory of Planned Behavior, this paper explores the perceptions of the COVID-19 vaccine among South Asian communities residing in the UK. Thirty-eight semi-structured interviews were conducted using a qualitative approach and analyzed using thematic analysis. Participants represented Indian, Pakistani, Bangladeshi, Sri Lankan, Afghani, and Nepali backgrounds. The participants revealed that family and community influence their perceptions of the COVID-19 vaccine. The results suggest that normalizing vaccine acceptance, addressing unknown side effects, and popularizing vaccine efficacy data will increase vaccine uptake within the South Asian community in the UK.
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Affiliation(s)
- M Bilal Akbar
- Nottingham Business School, Nottingham Trent University, Nottingham, UK
| | - Lakhbir Singh
- Department of Marketing, The University of the West of Scotland, UK
| | | | - Nihar Amoncar
- Department of Management, Institute of Management Technology, Ghaziabad, India
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25
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Alsuwailem SI, Okmi EA, Alkhaldi EH, Almutairi KS, Alshamari WK. Determinants of Flu Vaccine Uptake Among the General Population in Saudi Arabia: A Study Based on the Health Belief Model. Cureus 2023; 15:e41277. [PMID: 37533606 PMCID: PMC10392738 DOI: 10.7759/cureus.41277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
Background and objective Recently, influenza has emerged as a significant public health concern worldwide, including in Saudi Arabia. Vaccination against the flu is widely recognized as a crucial preventive measure to reduce morbidity and mortality associated with the virus. However, the uptake of flu vaccines among the general population in Saudi Arabia still remains low. In light of this, this study aimed to examine the determinants of influenza vaccine uptake in Saudi Arabia by using the Health Belief Model (HBM). Methods This cross-sectional study was conducted among adults living in all regions of Saudi Arabia by using an online self-administered questionnaire based on the HBM. The questionnaire inquired about demographics, knowledge about influenza, knowledge about vaccines, and beliefs/barriers. It was distributed via social media platforms, including WhatsApp, Twitter, and Instagram. IBM SPSS Statistics software version 29 (IBM Corp., Armonk, NY) was used for statistical analyses, and both the Chi-square test and logic regression analyses were applied to determine associations between explanatory and response variables, with the level of significance set at p<0.05. Results This study enrolled a total of 1040 participants, and the majority were Saudi nationals (96.9%). Of note, 66.2% of the participants were males, and the rest were females. Most of the participants were employed by governmental institutions (42.0%), had bachelor's degrees (58.4%), had never worked in the health sector (70.2%), and earned above 10,000 Saudi riyals per month (62.1%). Over half (55.7%) of participants had taken the flu vaccine at the time of this study. Working in the healthcare sector was associated with increased flu vaccine uptake [adjusted odds ratio (aOR): 3.84, p<0.001]. The likelihood of getting the flu vaccines was greater among men (aOR: 1.38, p=0.027), and obesity was associated with lower flu vaccine uptake (aOR: 0.29, p=0.034). Having contact with people with flu, having had flu in the past, and experiencing severe flu complications (aOR: 4.71, p=0.029; aOR: 0.13, p=0.006; and aOR: 0.29, p=0.033, respectively) were significantly associated with the flu vaccine uptake among our study participants. Perceived potential risks of the flu vaccine were also associated with taking the flu vaccine (aOR: 0.213, p=0.042). There was a significant association between seeing an advertisement for the flu vaccine and the likelihood of taking the vaccine (aOR: 5.488, p=0.042). Conclusion This study found that certain sociodemographic factors are associated with flu vaccine uptake. These factors included contact with flu-infected individuals, past experiences with flu, perceived risks, and exposure to flu vaccine advertisements. Improving healthcare accessibility, conducting awareness campaigns, and implementing workplace initiatives are recommended to address the issues related to flu vaccine uptake.
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Affiliation(s)
| | - Ezzuddin A Okmi
- Respiratory Infectious Diseases Prevention and Control, Saudi Public Health Authority, Riyadh, SAU
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26
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Hashim A, Taha Y. The Role of Sudanese Doctors in the United Kingdom in Mitigating COVID-19 Vaccine Hesitancy Among Their Diaspora Communities. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200447. [PMID: 37348947 PMCID: PMC10285733 DOI: 10.9745/ghsp-d-22-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/04/2023] [Indexed: 06/24/2023]
Abstract
People from ethnic minority groups are at risk of adverse sequelae of COVID-19, but their vaccine acceptance and enrollment rates remain suboptimal. Diaspora communities are unique in that they continue to engage in epistemic networks related to vaccination with dwellers in their country of origin. We describe the COVID-19 vaccine awareness campaign we conducted from January 2021 to November 2021 for Sudanese diaspora groups in the United Kingdom and the various techniques and methods used by health care professionals from the same ethnocultural background to address vaccine reluctance among this cohort. We explore the impact of our joint efforts with local authorities in Sudan to overcome the initial barriers to the national vaccination program in Sudan. The influence of the intercommunication between the diaspora and their relatives at home regarding COVID-19 vaccine misinformation is also discussed. Finally, we highlight these observations as key areas for future research to improve the global impact of vaccine deployment in pandemic situations.
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Affiliation(s)
- Ahmed Hashim
- Royal Free London NHS Foundation Trust, London, United Kingdom.
| | - Yusri Taha
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, London, United Kingdom
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27
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Padonou SGR, Kakaï Glèlè C, Accrombessi M, Adegbite BR, Dangbenon E, Bah H, Akogbeto E, Bah Chabi AI, Kaucley L, Sourakatou S, Dossou A, Batonon A, Bissouma-Ledjou T, Hounkpatin B. Assessment of COVID-19 Vaccine Acceptance and Its Associated Factors during the Crisis: A Community-Based Cross-Sectional Study in Benin. Vaccines (Basel) 2023; 11:1104. [PMID: 37376493 PMCID: PMC10305180 DOI: 10.3390/vaccines11061104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period. METHODS From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance. RESULTS A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population's request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance. CONCLUSION The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages.
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Affiliation(s)
| | | | - Manfred Accrombessi
- Disease Control Department, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London WC1E 7HT, UK
- African Public Health Consulting and Research Group, Cotonou, Benin
- Cotonou Entomological Research Center, Ministry of Health, Cotonou 06 BP 2604, Benin
| | - Bayode Romeo Adegbite
- Alliance for the Promotion of Community Health, Research and Scientific Innovation, Cotonou, Benin
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Centre de Recherches Médicales de Lambaréné, Lambarene BP242, Gabon
| | - Edouard Dangbenon
- African Public Health Consulting and Research Group, Cotonou, Benin
- Cotonou Entomological Research Center, Ministry of Health, Cotonou 06 BP 2604, Benin
| | - Houssaïnatou Bah
- Country Office, World Health Organization, Cotonou 01BP 918, Benin
| | | | | | | | | | - Ange Dossou
- Ministry of Health, Cotonou 01 BP 882, Benin
| | | | | | - Benjamin Hounkpatin
- Ministry of Health, Cotonou 01 BP 882, Benin
- Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou 01 BP 526, Benin
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Xie L, Wang D, Ma F. Analysis of individual characteristics influencing user polarization in COVID-19 vaccine hesitancy. COMPUTERS IN HUMAN BEHAVIOR 2023; 143:107649. [PMID: 36683861 PMCID: PMC9844095 DOI: 10.1016/j.chb.2022.107649] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
During the COVID-19 pandemic, vaccine hesitancy proved to be a major obstacle in efforts to control and mitigate the negative consequences of COVID-19. This study centered on the degree of polarization on social media about vaccine use and contributing factors to vaccine hesitancy among social media users. Examining the discussion about COVID-19 vaccine on the Weibo platform, a relatively comprehensive system of user features was constructed based on psychological theories and models such as the curiosity-drive theory and the big five model of personality. Then machine learning methods were used to explore the paramount impacting factors that led users into polarization. Findings revealed that factors reflecting the activity and effectiveness of social media use promoted user polarization. In contrast, features reflecting users' information processing ability and personal qualities had a negative impact on polarization. This study hopes to help healthcare organizations and governments understand and curb social media polarization around vaccine development in the face of future surges of pandemics.
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Affiliation(s)
- Lei Xie
- School of Information Management, Wuhan University, Wuhan, 430072, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China
| | - Dandan Wang
- School of Information Management, Wuhan University, Wuhan, 430072, China,School of Data Science, City University of Hong Kong, Hong Kong, 999077, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China
| | - Feicheng Ma
- School of Information Management, Wuhan University, Wuhan, 430072, China,Center for Studies of Information Resources, Wuhan University, Wuhan, 430072, China,Big Data Institute, Wuhan University, Wuhan, 430072, China,Corresponding author. School of Information Management, Wuhan University, Wuhan, China
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29
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Amdany H, Koech B. Best practice implementation on reporting of coronavirus disease 2019 vaccine adverse events following immunization in Uasin Gishu County, Kenya. JBI Evid Implement 2023; 21:146-155. [PMID: 36545897 DOI: 10.1097/xeb.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This project's aim was to implement vaccine safety surveillance best practices to improve reporting of adverse events following immunization (AEFI) during coronavirus disease 2019 (COVID-19) vaccination roll out in Uasin Gishu County. INTRODUCTION Weak vaccine safety surveillance systems in developing countries has contributed to underreporting of AEFIs undermining public confidence in immunization efforts, contributing to low uptake of vaccines critical in the fight against communicable diseases. METHODS The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice was utilized. Preimplementation and postimplementation audit cycles carried out utilized six best practice recommendations. Context-specific strategies and resources were used to address the gaps identified. RESULTS Less than half of the AEFIs reported were in accordance with the local policy recommendation, and most of the AEFIs reported were submitted in a timely manner in the baseline and follow-up cycle. Slight improvement was recorded in the number of health facilities with AEFIs reporting forms. An improvement of 33.7% was recorded in the number of health workers providing COVID-19 vaccination services who had received education and practical training on vaccine pharmacovigilance. CONCLUSION Underreporting and delayed submission of COVID-19 vaccine AEFI was evident among the healthcare providers offering COVID-19 vaccination services, the majority of healthcare providers had received training on vaccine pharmacovigilance, and AEFI hard copy reporting forms were not adequate in the health facilities. Public education on vaccine safety before administration of vaccine needs emphasis in order to improve reporting of AEFI.
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Albayat S, Almaslamani M, Alromaihi H, Khogali H, Mundodan J, Joury J, Haridy H. Key Lessons from COVID-19: A Narrative Review Describing Qatar's Multifactorial Approach in Executing a Vaccination Campaign. Vaccines (Basel) 2023; 11:vaccines11050953. [PMID: 37243057 DOI: 10.3390/vaccines11050953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Widespread vaccination programs have been implemented in many countries to curtail the COVID-19 pandemic, with varying success and challenges. To better understand the successes and challenges of the global COVID-19 response in the face of emerging new variants and epidemiologic data, we discuss how Qatar engaged the healthcare sector, governmental bodies, and the populace to combat COVID-19, with a focus on the country's vaccination strategy. This narrative provides the history and timeline of the Qatar COVID-19 vaccination campaign; factors that helped the vaccination campaign and the transferable lessons learned are discussed. Details regarding how Qatar responded to challenges, such as vaccine hesitancy and mitigation of misinformation, are highlighted. Qatar was one of the first countries to procure the BNT162b2 (Comirnaty®; Pfizer-BioNTech, Pfizer Inc., New York, NY, USA) and mRNA-1273 (Spikevax®; Moderna, Cambridge, MA, USA) COVID-19 vaccines. A relatively high vaccination rate and low case mortality rate (0.14% as of 4 January 2023) was observed in Qatar compared with other countries (global case mortality rate, 1.02%). Learnings will be carried forward as a basis for addressing this evolving pandemic and any future national emergencies in Qatar.
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Affiliation(s)
- Soha Albayat
- Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Muna Almaslamani
- Communicable Disease Center, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | | | | | | | - Jean Joury
- Pfizer Gulf FZ LLC, Dubai P.O. Box 502749, United Arab Emirates
| | - Hammam Haridy
- Pfizer Gulf FZ LLC, Dubai P.O. Box 502749, United Arab Emirates
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31
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Kumari M, Mondal H, Marndi G, Juhi A. Evaluation of the Effectiveness of a Structured Educational Program on Improving the Knowledge of COVID-19 Among the Vaccine-Reluctant Population in a Block of Jharkhand, India. Cureus 2023; 15:e38628. [PMID: 37284394 PMCID: PMC10241108 DOI: 10.7759/cureus.38628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Background Low vaccination uptake is a major public health concern and is more prevalent in rural areas. Educational interventions have been proposed as an effective strategy to increase vaccine acceptance. The objective of this study was to assess the impact of an educational program on acquiring knowledge for promoting vaccination uptake among a sample of participants. Methodology This study was conducted in a rural area in the state of Jharkhand, India. The study period was from July 2022 to September 2022. The area was surveyed for COVID-19 vaccination and a total of 510 people did not take any dose or took only the first dose and then skipped the second dose. An educational program was designed in the local language. The knowledge of the sample was assessed before and after a week of intervention with a surveyor-administered questionnaire. The vaccination status before and after the intervention was also recorded. We used the chi-square test, Fisher's exact test, and binomial test for comparing the categorical variables. Results A total of 178 participants' data were analyzed. The majority of the participants were in the age group of 18-25 years. The pre-intervention score regarding the knowledge of COVID-19 and vaccination was 18.93 ± 5.10 which significantly increased after the intervention to 25.06 ± 4.35 (p <0.0001). The number of individuals receiving vaccination significantly increased. Before the program, 95 participants did not take the vaccine and 83 received the first dose and did not take the second dose. After the program, 17 participants did not take the vaccine, 161 completed the first dose, and 112 completed the second dose (p <0.0001). Conclusions The educational program was successful in improving knowledge and awareness about vaccination, leading to an increase in the number of individuals receiving vaccination. These findings suggest the importance of educational interventions in the local language in promoting vaccination uptake and can be used to design effective public health campaigns to increase vaccine acceptance.
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Affiliation(s)
- Muskan Kumari
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Gujaram Marndi
- Pharmacology, Dharanidhar Medical College and Hospital, Keonjhar, Kendujhar, IND
| | - Ayesha Juhi
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Mahameed H, Al-Mahzoum K, AlRaie LA, Aburumman R, Al-Naimat H, Alhiary S, Barakat M, Al-Tammemi AB, Salim NA, Sallam M. Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination. Vaccines (Basel) 2023; 11:vaccines11050897. [PMID: 37243001 DOI: 10.3390/vaccines11050897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.
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Affiliation(s)
- Haneen Mahameed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Hala Al-Naimat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sakher Alhiary
- Nursing Department, Jordan University Hospital, Amman 11942, Jordan
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Ala'a B Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), The UN Migration Agency, Amman 11953, Jordan
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Amman 11942, Jordan
- Prosthodontic Department, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
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Satti EM, Elhadi YAM, Ahmed KO, Ibrahim A, Alghamdi A, Alotaibi E, Yousif BA. The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050817. [PMID: 37241049 DOI: 10.3390/medicina59050817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.
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Affiliation(s)
- Einass M Satti
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan
| | | | - Kannan O Ahmed
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani 21112, Sudan
| | - Alnada Ibrahim
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Ahlam Alghamdi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Eman Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Bashir A Yousif
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan
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Contreras J, Fincannon A, Khambaty T, Villalonga-Olives E. Emergent Social Capital during the Coronavirus Pandemic in the United States in Hispanics/Latinos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085465. [PMID: 37107747 PMCID: PMC10138722 DOI: 10.3390/ijerph20085465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/11/2023]
Abstract
The coronavirus pandemic has drastically impacted many groups that have been socially and economically marginalized such as Hispanics/Latinos in the United States (U.S.). Our aim was to understand how bonding social capital, bridging social capital, and trust played a role in Hispanics/Latinos over the course of the COVID-19 outbreak, as well as explore the negative consequences of social capital. We performed focus group discussions via Zoom (n = 25) between January and December 2021 with Hispanics/Latinos from Baltimore, MD, Washington, DC, and New York City, NY. Our findings suggest that Hispanics/Latinos experienced bridging and bonding social capital. Of particular interest was how social capital permeated the Hispanic/Latino community's socioeconomic challenges during the pandemic. The focus groups revealed the importance of trust and its role in vaccine hesitancy. Additionally, the focus groups discussed the dark side of social capital including caregiving burden and spread of misinformation. We also identified the emergent theme of racism. Future public health interventions should invest in social capital, especially for groups that have been historically marginalized or made vulnerable, and consider the promotion of bonding and bridging social capital and trust. When prospective disasters occur, public health interventions should support vulnerable populations that are overwhelmed with caregiving burden and are susceptible to misinformation.
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Affiliation(s)
- Jennifer Contreras
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Alexandra Fincannon
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Ester Villalonga-Olives
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
- Correspondence:
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Yildiz Durak H, Şimşir Gökalp Z, Saritepeci M, Dilmaç B, Durak A. Investigation of personal variables, technology usage, vaccine-related variables, social media-specific epistemological beliefs, media literacy, social impact strategies variables affecting vaccine hesitancy beliefs in the Covid-19 pandemic. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-14. [PMID: 37361268 PMCID: PMC10013284 DOI: 10.1007/s10389-023-01872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
Aim In this study, personal variables, technology use cases, vaccine-related variables, social media-specific epistemological beliefs, media literacy, and social influence strategies were examined as predictors of Covid-19 vaccination hesitancy (VH) beliefs. Subject and methods The prediction design research model is used to detect the predictors of the dependent variable. The study group consists of 378 participants. Five different scales were used together with the self-description form as a data collection tool. Results According to the results of the research, individuals who have positive perceptions about the safety of Covid-19 vaccines and who have received the Covid-19 vaccine have lower anti-vaccine beliefs. It is another situation that prevents the opposition to vaccination of those who research the source of information on social media. As a result, age, education and income level, social media usage experience, media literacy, and social influence strategies were not effective on the participants' anti-vaccine beliefs. Conclusion According to the findings of the study, positive perceptions about the safety of Covid-19 vaccines, being vaccinated against Covid-19, and researching a source of information on social media variables seem to be effective in laying the foundations for constructive interventions such as using anti-vaccine beliefs to guide, reduce or eliminate negative beliefs about vaccines.
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Affiliation(s)
- Hatice Yildiz Durak
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Zeynep Şimşir Gökalp
- Faculty of Education, Department of Educational Sciences, Selçuk University, Konya, Turkey
| | - Mustafa Saritepeci
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Bülent Dilmaç
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Aykut Durak
- Eregli Faculty of Education, Necmettin Erbakan University, Konya, Turkey
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Chirico F, Teixeira da Silva JA. Evidence-based policies in public health to address COVID-19 vaccine hesitancy. Future Virol 2023; 18:10.2217/fvl-2022-0028. [PMID: 37034451 PMCID: PMC10079004 DOI: 10.2217/fvl-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023]
Abstract
A fundamental basis for effective health-related policymaking of any democratic nation should be open and transparent communication between a government and its citizens, including scientists and healthcare professionals, to foster a climate of trust, especially during the ongoing COVID-19 mass vaccination campaign. Since misinformation is a leading cause of vaccine hesitancy, open data sharing through an evidence-based approach may render the communication of health strategies developed by policymakers with the public more effective, allowing misinformation and claims that are not backed by scientific evidence to be tackled. In this narrative review, we debate possible causes of COVID-19 vaccine hesitancy and links to the COVID-19 misinformation epidemic. We also put forward plausible solutions as recommended in the literature.
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Affiliation(s)
- Francesco Chirico
- Post-graduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Wu J, Shen Z, Li Q, Tarimo CS, Wang M, Gu J, Wei W, Zhang X, Huang Y, Ma M, Xu D, Ojangba T, Miao Y. How urban versus rural residency relates to COVID-19 vaccine hesitancy: A large-scale national Chinese study. Soc Sci Med 2023; 320:115695. [PMID: 36736053 PMCID: PMC9846885 DOI: 10.1016/j.socscimed.2023.115695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
RATIONALE Although urban-rural residency has been shown to influence individual COVID-19 vaccine hesitancy, the differences between urban and rural China have yet to be uncovered. OBJECTIVE This study aims to assess the current prevalence and factors associated with COVID-19 vaccine hesitancy in urban and rural areas and explore whether the rural versus urban residency is associated with COVID-19 vaccine hesitancy. METHODS A national, cross-sectional, online survey among Chinese urban and rural adults (≥18 years old) was conducted from 6th to August 9, 2021. A questionnaire was used to collect data on sociodemographic factors, perceptions of the COVID-19 pandemic and vaccination status. A multivariable logistic regression model was used to identify the factors that influence COVID-19 vaccine hesitancy. Propensity score matching (PSM) analysis was performed to explore the association between urban versus rural residency and COVID-19 vaccine hesitancy. RESULTS In total, 29,925 participants (80.56% urban participants) were recruited. Urban participants had a higher COVID-19 vaccine hesitancy than their rural counterparts (9.39% vs. 4.26%). After adjusting for potential confounders, we found that COVID-19 vaccine hesitancy among females was lower than that in males in both urban (aOR = 0.78, 95% CI [0.69-0.88]) and rural areas (aOR = 0.54, 95% CI [0.39-0.75]). The lack of trust towards vaccine producers was found to be associated with vaccine hesitancy among the urban participants (aOR = 2.76, 95% CI [2.22-3.43]). The rural floating population had a lower COVID-19 vaccine hesitancy than the rural permanent residents (aOR = 0.58, 95% CI [0.42-0.80]). PSM analysis revealed a 2.38% difference in COVID-19 vaccine hesitancy between urban and rural participants. CONCLUSIONS Urban participants were more hesitant to receive the COVID-19 vaccine than rural participants. Priority should be placed on boosting confidence in the healthcare system to reduce COVID-19 vaccine hesitancy among urban residents. Furthermore, we advocate for extra incentives and vaccination education for rural permanent residents.
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Affiliation(s)
- Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Quanman Li
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Clifford Silver Tarimo
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China; Department of Science and Laboratory Technology, Dar es salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Meiyun Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Jianqin Gu
- School of Medicine, Southern University of Science and Technology, Guangdong, People's Republic of China
| | - Wei Wei
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Yanli Huang
- Manage and service Center of Wuhou Medical Institutes, Sichuan, People's Republic of China
| | - Mingze Ma
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Dongyang Xu
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Theodora Ojangba
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China.
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Colvin KM, Camara KS, Adams LS, Sarpong AP, Fuller DG, Peck SE, Ramos AS, Acevedo AL, Badume MA, Briggs SLA, Chukwurah TN, Davila-Gutierrez Z, Ewing JA, Frempong JO, Garrett AA, Grampp SJ, Gillespie JW, Herrera EJ, Horsford SME, Maddox EJ, Pelaez JC, Quartey OL, Rodriguez F, Vasquez LA, Piper BJ, Gowtham S. Profiles of COVID-19 vaccine hesitancy by race and ethnicity in eastern Pennsylvania. PLoS One 2023; 18:e0280245. [PMID: 36745588 PMCID: PMC9901750 DOI: 10.1371/journal.pone.0280245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/23/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Throughout US history, chronic and infectious diseases have severely impacted minority communities due to a lack of accessibility to quality healthcare and accurate information, as well as underlying racism. These fault lines in the care of minority communities in the US have been further exacerbated by the rise of the COVID-19 pandemic. This study examined the factors associated with COVID-19 vaccine hesitancy by race and ethnicity, particularly among African American and Latinx communities in Eastern Pennsylvania (PA). METHODS Survey data was collected in July 2021 in Philadelphia, Scranton, Wilkes-Barre, and Hazleton, PA. The 203 participants (38.7% Black, 27.5% Latinx) completed the 28-question survey of COVID-19 vaccination attitudes in either English or Spanish. RESULT Out of the 203 participants, 181 participants met all the inclusion criteria, including completed surveys; of these participants, over three-fifths (63.5%) were acceptant of the COVID-19 vaccine whereas the remainder (36.5%) were hesitant. Binary logistic regression results showed that age, concern for vaccine efficacy, race, knowledge on the vaccine, and belief that the COVID-19 virus is serious significantly influenced COVID-19 vaccine hesitancy. Minorities were more likely to be hesitant toward vaccination (OR: 2.8, 95% CI: 1.1, 6.8) than non-Hispanic whites. Those who believed the COVID-19 vaccine was ineffective (OR: 8.3, 95% CI: 3.8, 18.2), and that the virus is not serious (OR: 8.3, 95% CI: 1.1, 61.8) showed the greatest odds of hesitancy. CONCLUSIONS Minority status, age less than 45 years, misinformation about seriousness of COVID-19 illness, and concern about vaccine efficacy were contributing factors of COVID-19 vaccine hesitancy. Therefore, understanding and addressing the barriers to COVID-19 vaccination in minority groups is essential to decreasing transmission and controlling this pandemic, and will provide lessons on how to implement public health measures in future pandemics.
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Affiliation(s)
- Kenya M. Colvin
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Kennedy S. Camara
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Latasha S. Adams
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Adline P. Sarpong
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Danielle G. Fuller
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Sadie E. Peck
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Anthony S. Ramos
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Ariana L. Acevedo
- Wilkes University, Wilkes-Barre, Pennsylvania, United States of America
| | - Meless A. Badume
- Swarthmore College, Swarthmore, Pennsylvania, United States of America
| | | | | | | | - James A. Ewing
- Temple University, Philadelphia, Pennsylvania, United States of America
| | | | - Amirah A. Garrett
- Temple University, Philadelphia, Pennsylvania, United States of America
| | - Steven J. Grampp
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | | | | | - Shantia M. E. Horsford
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Emis J. Maddox
- University of Scranton, Scranton, Pennsylvania, United States of America
| | - John C. Pelaez
- Susquehanna University, Selinsgrove, Pennsylvania, United States of America
| | - Olivia L. Quartey
- Temple University, Philadelphia, Pennsylvania, United States of America
| | - Fanny Rodriguez
- University of Scranton, Scranton, Pennsylvania, United States of America
| | - Luis A. Vasquez
- University of Scranton, Scranton, Pennsylvania, United States of America
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, Pennsylvania, United States of America
| | - Swathi Gowtham
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
- Department of Pediatrics, Pediatric Infectious Diseases, Geisinger Medical Center, Danville, Pennsylvania, United States of America
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AlShurman BA, Butt ZA. Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1561. [PMID: 36674314 PMCID: PMC9864682 DOI: 10.3390/ijerph20021561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.
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Affiliation(s)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Yu L, Qiao J, Ming WK, Wu Y. Megastudies: A New Approach to Reducing Vaccine Hesitation Worldwide. Vaccines (Basel) 2023; 11:vaccines11010133. [PMID: 36679978 PMCID: PMC9865671 DOI: 10.3390/vaccines11010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
Vaccine hesitancy is a considerable obstacle to achieving vaccine protection worldwide. There needs to be more evidence-based research for interventions for vaccine hesitancy. Existing effectiveness evaluations are limited to one particular hypothesis, and no studies have compared the effectiveness of different interventions. A megastudy takes a large-scale, multi-intervention, uniform participant and the same evaluation criteria approach to evaluate many interventions simultaneously and find the most effective ones. Therefore, megastudies can help us find the most effective interventions for vaccine hesitancy. Additionally, considering the complex causes of vaccine hesitancy, we design interventions that involve social factors in megastudies. Lastly, quality control and justice are critical issues for megastudies in the future.
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Affiliation(s)
- Lian Yu
- Health Care System Reform and Development Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jiaqi Qiao
- Jinhe Center for Economic Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong 999077, China
- Correspondence: (W.-K.M.); (Y.W.); Tel.: +85-234-426-956 (W.-K.M.); +861-881-016-9630 (Y.W.)
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (W.-K.M.); (Y.W.); Tel.: +85-234-426-956 (W.-K.M.); +861-881-016-9630 (Y.W.)
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Zhang L, Yang J, Cao Y, Kang W. Sociocultural-psychological predictors influencing parents' decision-making regarding HPV vaccination for their adolescent daughters in mainland China: An extended TPB model. Front Public Health 2023; 10:1035658. [PMID: 36684984 PMCID: PMC9853056 DOI: 10.3389/fpubh.2022.1035658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Enhancing human papillomavirus (HPV) vaccine uptake rates to protect women's health is an important public health issue worldwide. China has taken a series of measures in recent years to promote HPV vaccination among school-aged girls, but the vaccine uptake rate remains low. Investigating the factors influencing vaccination-related decision-making of adolescent girls' parents is key to solving the problem. This study aimed to examine the influence of sociocultural-psychological predictors, including exposure to HPV-related stories (positive/negative), affective reactions (pride/regret), injunctive norms on the Internet and perceived moral obligation, on parents' HPV vaccination-related decision-making for girls aged 13-15 years in mainland China. Methods A cross-sectional online survey using quota sampling was conducted in February 2022. Four hundred and five valid and qualified questionnaires were obtained. Partial least squares structural equation modeling was performed by SmartPLS 3 (i) to evaluate the reliability and validity of the measurement models of 11 constructs, and (ii) to test the effect relationships of the sociocultural-psychological predictors on parents' intention to vaccinate their daughters. Results The study findings showed that parental decision-making regarding HPV vaccination was influenced by sociocultural and psychological factors. At the level of individual psychological factors, exposure to positive stories was significantly associated with perceived vaccine effectiveness (β = 0.331, t = 8.448, p < 0.001), which strongly predicted the attitude toward vaccination (β = 0.521, t = 8.133, p < 0.001); anticipated pride had more positive influence on vaccination-related decision-making (β = 0.156, t = 2.176, p < 0.05) than anticipated regret. In terms of social influence, injunctive norms on the Internet had a significantly positive influence on vaccination intention (β = 0.127, t = 2.382, p < 0.05), similar to descriptive norms (β = 0.135, t = 3.358, p < 0.01). Perceived moral obligation at the cultural level was the strongest predictor of parental decision-making regarding HPV vaccination (β = 0.193, t = 2.139, p < 0.05). Discussion This study is the first in mainland China to systematically examine the sociocultural-psychological predictors of parents' decision-making to vaccinate their 13-15-year-old daughters against HPV. A new extended TPB model with a sociocultural-psychological approach was developed. This model can support the investigation of factors affecting HPV vaccine uptake rates in the mainland Chinese population and similar populations and help to understand the differences in vaccination-related decision-making between Eastern and Western cultures. Furthermore, the study provided some suggestions for HPV vaccination communication campaigns targeting adolescent girls' parents.
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Affiliation(s)
- Lingmin Zhang
- School of Journalism and Communication, Guangzhou University, Guangzhou, China
| | - Jian Yang
- School of Journalism and Communication, Guangzhou University, Guangzhou, China,*Correspondence: Jian Yang ✉
| | - Ye Cao
- Archives Office, Guizhou Open University, Guiyang, China
| | - Wanying Kang
- School of Media and Communication, Shenzhen University, Shenzhen, China
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Mathews KO, Norris JM, Phalen D, Malikides N, Savage C, Sheehy PA, Bosward KL. Factors associated with Q fever vaccination in Australian wildlife rehabilitators. Vaccine 2023; 41:201-210. [PMID: 36424259 DOI: 10.1016/j.vaccine.2022.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
Australian wildlife rehabilitators (AWR) are at risk of contracting Q fever, a serious zoonotic disease caused by Coxiella burnetii. Despite Australian government recommendations for AWR to receive Q fever vaccination (QFV), and the availability of a safe and effective vaccine in Australia, shortfalls in vaccine uptake have been observed in AWR. This study aimed to determine factors associated with QFV status and describe AWR attitudes and potential barriers towards QFV. Data were obtained from a nationwide, online, cross-sectional survey of AWR undertaken in 2018. Approximately-three quarters (200/265; 75.5 %) of those that had heard of Q fever were also aware of the Q fever vaccine, and of those, 25.5 % (51/200) were vaccinated. Barriers to QFV, among unvaccinated respondents who had also heard of Q fever and the vaccine (149/200; 74.5 %), included concerns regarding the safety, efficacy, and importance of the Q fever vaccine. Complacency toward vaccination, convenience of vaccination, and a lack of Q fever knowledge were also notable barriers. Only 27.7 % (41/148) of respondents reported having had vaccination recommended to them. Multivariable logistic regression identified that vaccinated AWR were more likely to be aged ≤ 50 years (OR 4.51, 95 % CI: 2.14-10.11), have had a university level education (OR 2.78, 95 % CI: 1.39-5.73), have resided in New South Wales/Australian Capital Territory and Queensland than in other Australian jurisdictions (OR 2.9, 95 % CI: 1.10-8.83 and OR 4.82, 95 % CI: 1.64-16.00 respectively) and have attended an animal birth (OR 2.14, 95 % CI: 1.02-4.73). Knowledge gaps regarding Q fever and QFV in AWR demonstrated the need for interventions to raise the awareness of the potential health consequences of C. burnetii exposure and Q fever prevention. Education programs to allow AWR to develop an informed perspective of Q fever and QFV, coupled with improvements in vaccine affordability and the implementation of programs to enhance accessibility, may also increase vaccine uptake.
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Affiliation(s)
- Karen O Mathews
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jacqueline M Norris
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Sydney 2006, New South Wales, Australia
| | - David Phalen
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | | | | | - Paul A Sheehy
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Katrina L Bosward
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Sydney 2006, New South Wales, Australia.
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Harris K, Ling Y, Bukhbinder AS, Chen L, Phelps KN, Cruz G, Thomas J, Kim Y, Jiang X, Schulz PE. The Impact of Routine Vaccinations on Alzheimer's Disease Risk in Persons 65 Years and Older: A Claims-Based Cohort Study using Propensity Score Matching. J Alzheimers Dis 2023; 95:703-718. [PMID: 37574727 PMCID: PMC10578243 DOI: 10.3233/jad-221231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Accumulating evidence suggests that adult vaccinations can reduce the risk of developing Alzheimer's disease (AD) and Alzheimer's disease related dementias. OBJECTIVE To compare the risk for developing AD between adults with and without prior vaccination against tetanus and diphtheria, with or without pertussis (Tdap/Td); herpes zoster (HZ); or pneumococcus. METHODS A retrospective cohort study was performed using Optum's de-identified Clinformatics® Data Mart Database. Included patients were free of dementia during a 2-year look-back period and were≥65 years old by the start of the 8-year follow-up period. We compared two similar cohorts identified using propensity score matching (PSM), one vaccinated and another unvaccinated, with Tdap/Td, HZ, or pneumococcal vaccines. We calculated the relative risk (RR) and absolute risk reduction (ARR) for developing AD. RESULTS For the Tdap/Td vaccine, 7.2% (n = 8,370) of vaccinated patients and 10.2% (n = 11,857) of unvaccinated patients developed AD during follow-up; the RR was 0.70 (95% CI, 0.68-0.72) and ARR was 0.03 (95% CI, 0.02-0.03). For the HZ vaccine, 8.1% (n = 16,106) of vaccinated patients and 10.7% (n = 21,417) of unvaccinated patients developed AD during follow-up; the RR was 0.75 (95% CI, 0.73-0.76) and ARR was 0.02 (95% CI, 0.02-0.02). For the pneumococcal vaccine, 7.92% (n = 20,583) of vaccinated patients and 10.9% (n = 28,558) of unvaccinated patients developed AD during follow-up; the RR was 0.73 (95% CI, 0.71-0.74) and ARR was 0.02 (95% CI, 0.02-0.03). CONCLUSION Several vaccinations, including Tdap/Td, HZ, and pneumococcal, are associated with a reduced risk for developing AD.
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Affiliation(s)
- Kristofer Harris
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yaobin Ling
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Avram S. Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Division of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Luyao Chen
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamal N. Phelps
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gabriela Cruz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jenna Thomas
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul E. Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Swarnamali H, Francis TV, Sooriyaarachchi P, Jayawardena R. COVID-19 vaccine hesitancy in Sri Lanka: A national level survey. Int J Health Sci (Qassim) 2023; 17:3-11. [PMID: 36704496 PMCID: PMC9832912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective It is important to understand the factors associated with vaccination hesitancy for a given population for successful coronavirus disease-2019 (COVID-19) immunization program. This survey aimed to examine the prevalence of vaccine hesitancy and associated sociodemographic factors. Methods A cross-sectional online survey was undertaken by circulating through social media platforms. Survey questions included sociodemographics and vaccination acquisition-related questions. Results The study comprised a total of 3621 respondents. Over one-fifth of the unvaccinated population were identified as vaccine hesitancy group. Ethnicity and district indicated significant associations with vaccine hesitancy (P < 0.05). Indian Tamils (Odds Radio [OR] 2.222; 95%Confidence interval [CI], 1.150-4.294; P = 0.018), Sri Lankan Tamils (OR 1.714; 95% CI, 1.181-2.488; P = 0.005), and Sri Lankan Moors (OR 1.913; 95% CI, 1.316-2.781; P = 0.001) had significantly higher odds of vaccine hesitancy when compared to the Sinhalese. People in rural areas also had greater odds of vaccine hesitancy (OR 1.339; 95% CI, 1.000-1.793; P = 0.05) compared to municipal council areas. Conclusion Vaccine hesitancy was considerably high in this survey population. Our results emphasize the need of the Sri Lankan government taking appropriate efforts to establish a targeted COVID-19 vaccination campaign plan for rural and Colombo district residents. Attention should also be given to ethnic minority groups.
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Affiliation(s)
- Hasinthi Swarnamali
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Tormalli V. Francis
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Piumika Sooriyaarachchi
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Ranil Jayawardena
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Šljivo A, Abdulkhaliq A, Granov N, Reiter L, Mahendran E, Zeglis I, Mohammed MA, Yousef A, Dadić I, Ivanović K, Selimović A, Mujičić E, Gabor-Harosa FM. COVID-19 vaccination knowledge, attitudes and practices among the general population of Romania during the third wave of COVID-19 pandemic. SAGE Open Med 2023; 11:20503121231165670. [PMID: 37089469 PMCID: PMC10111160 DOI: 10.1177/20503121231165670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/05/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Romania began its COVID-19 immunization programme with approved vaccinations in three stages, as follows: The first step of vaccination is for health and social professionals, the second stage is for high-risk persons and the third stage is for the remainder of the general public. This study aims at assessment of knowledge, attitude and practice towards COVID-19 and vaccination against COVID-19 in the Romanian population during the third wave of the pandemic. Methods This cross-sectional study was based on a Bosnian and Herzegovinian study on COVID-19 vaccination during the country's third wave of COVID-19 pandemic. Results Our study sample, dominantly female (629; 61.0%), with a bachelor's degree (734; 71.2%), either single (539; 52.3%) or in a relationship (363; 35.2%), engaged in intellectual labour (910; 88.3%) and living in an urban environment (874; 84.8%) with a mean age of 25.07 ± 8.21 years, 294 (28.5%) people with COVID-19 symptoms and 86 (8.3%) were tested COVID-19 positive, had a mean knowledge score of 16.38 ± 4.0 with correct answer rates on questions ranging from 30.1% to 88.2%. Being single (odds ratio = 3.92, p = 0.029) or in a relationship (odds ratio = 3.79, p = 0.034), having a bachelor's degree and higher (odds ratio = 1.61, p = 0.006) and being COVID-19 tested (odds ratio = 1.82, p < 0.001) were associated with higher knowledge test scores. Our sample had relatively optimistic attitudes towards final COVID-19 disease containment (712; 69.1%) and vaccination programmes (679; 65.9%). The majority of the sample followed socio-epidemiological measures and did not visit places of mass social gatherings (666; 64.1%) and wore masks (992; 95.7%) while being outside their home. In terms of vaccination rates, 382 (37.0%) of the individuals were presently immunized against COVID-19. Higher knowledge test scores (>15 points) (odds ratio = 1.66, p = 0.002) and positive attitudes of this study (odds ratio = 1.59, p = 0.001, odds ratio = 4.16, p < 0.001) were identified as independent predictors for vaccinating against COVID-19. Conclusion Romanian citizens have had good knowledge, optimistic attitudes and appropriate practices towards COVID-19 vaccination during the third wave of COVID-19 outbreak in the country. Higher knowledge regarding the disease and vaccination against it not only increased attitudes towards the end of the pandemic, but also increased the willingness to be vaccinated and to avoid infection risk factors.
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Affiliation(s)
- Armin Šljivo
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Armin Šljivo, Clinical Center University of
Sarajevo, University of Sarajevo, Emergency Medical Service of Canton Sarajevo,
Kolodvorska 14, Sarajevo 71 000, Bosnia and Herzegovina.
| | - Arian Abdulkhaliq
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Nermir Granov
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Leopold Reiter
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Eljakim Mahendran
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ioannis Zeglis
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Assy Yousef
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ilma Dadić
- Faculty of Medicine, University of
Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Amina Selimović
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ermina Mujičić
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Florina Maria Gabor-Harosa
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Smith SE, Sivertsen N, Lines L, De Bellis A. Decision making in vaccine hesitant parents and pregnant women - An integrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100062. [PMID: 38745627 PMCID: PMC11080481 DOI: 10.1016/j.ijnsa.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives : Vaccine refusal is increasing in Australia and is a major concern in high- and middle-income countries. There is evidence to suggest that some parents, even those who elect to immunise, may be vaccine hesitant with some manipulating the schedule by excluding or delaying some vaccines. The aim of this review was to gain an understanding of factors that influence vaccine decision-making in pregnant women and parents of children. Design : An integrative review approach was used to produce an analysis of existing literature on vaccine decision-making in pregnancy and parents. As the broadest of review methods, an integrative review can include a range of experimental and non-experimental research, thereby ensuring the inclusion of data from multiple perspectives. Data Sources : Online databases were searched for research related to vaccine decision-making in pregnant women and parents. Original and review articles were sought that were published in English between 2015 and 2021. Reviewed articles included qualitative and quantitative studies and systematic reviews. No mixed methods papers were located or excluded from this review. Review methods : The review method was an integrative review informed by Coughlan. Results : Papers from thirteen predominantly high- and middle-income countries were selected for this review. A total of 31 articles fit the inclusion/exclusion criteria, including qualitative, quantitative and review articles. Three main themes were identified including the role of healthcare professionals, vaccine safety concerns and alternative influences. Alternative influences included: social media, friends and family, religion, conspiracy theories and salutogenic parenting. Findings suggest that high levels of anxiety are involved in vaccine decision-making with parents seeking information from multiple sources including healthcare professionals, friends and family and social media. Conclusions : Pregnancy is an ideal time to provide education on both pregnancy and childhood vaccinations. However, some parents reported dissatisfaction in their therapeutic relationships with healthcare professionals. As a result, parents can resort to their own information seeking, in the main via social media which has been linked to vaccine refusal. Additionally, some healthcare professionals report feeling inadequately prepared for the role of immunisation promotion and provision. Parental information seeking from non-traditional sources has been shown to result in the acquisition of misinformation, exposure to conspiracy theories, the inevitable loss of vaccine confidence and subsequent vaccine refusal.
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Affiliation(s)
- Susan E Smith
- Flinders University College of nursing and health science, Australia
| | - Nina Sivertsen
- Flinders University College of nursing and health science, Australia
- Arctic University of Norway, Rural and Remote Arctic Health, Campus Hammersfest
| | - Lauren Lines
- Flinders University College of nursing and health science, Australia
| | - Anita De Bellis
- Flinders University College of nursing and health science, Australia
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Perception and willingness to accept COVID-19 Vaccines: A cross-sectional survey of the general population of Sokoto State, Nigeria. PLoS One 2022; 17:e0278332. [PMID: 36454892 PMCID: PMC9714919 DOI: 10.1371/journal.pone.0278332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
The number of confirmed cases of COVID-19 globally is well over 400 million, however, the number of cases is showing a downward trend especially in developed countries largely as a result of effective vaccination against COVID-19. In developing countries, vaccination coverage is still very low as a result of vaccine hesitancy, which could be attributed to misconceptions about COVID-19 itself and its newly developed vaccines. This study assessed COVID-19 vaccine acceptance and perception amongst the adult population in Sokoto state, Nigeria. A cross-sectional study was conducted in Sokoto state among 854 respondents selected via a multi-stage sampling technique. Data was collected electronically using a set of structured questionnaire and analysis was done using IBM SPSS version 25. Respondents' perception was assessed using a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Respondents having a score of 3 and below were graded as having poor perception and those having scores above 3 were graded as having good perception. Respondents' ages ranged from 17 to 76 years, with a mean of 34.8±12.07; more than half [474(53.7%)] of the respondents were males, 667(75.5%) were married and 539(61.0%) had formal education. The majority [839(95.0%)] of the respondents had a good perception of COVID -19 vaccine; 49.9% agreed enough research would be required on the safety of the vaccine. The majority, (72.4%) expressed their willingness to accept the COVID- 19 vaccine (male 38.4% vs. female 34.0%); 410(47.4%) said they can spend more than one hour to get the vaccine. Significant predictors of willingness to accept COVID 19 vaccine include age (p = 0.006; aOR = 0.223; 95% CI = 0.077-0.645), education (p<0.001; aOR = 1.720; 95% CI = 1.274-2.321) and perception of COVID 19 vaccine (p<0.001; aOR = 0.020; 95% CI = 0.009-0.044). The majority of the respondents had a good perception of COVID- 19 vaccine and more than two-thirds were willing to be vaccinated with the vaccine. Government should make the vaccine available for vaccination since a significant proportion of the respondents expressed their willingness to accept the vaccine.
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Saigí-Rubió F, Eguia H, Espelt A, Macip S, Bosque-Prous M. Hesitation about coronavirus vaccines in healthcare professionals and general population in Spain. PLoS One 2022; 17:e0277899. [PMID: 36454968 PMCID: PMC9714825 DOI: 10.1371/journal.pone.0277899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 11/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study attempts to provide a picture of the hesitancy to vaccination against COVID-19 in Spain during the 2021 spring-autumn vaccination campaign, both in the general population and in healthcare professionals. METHODS The participants were recruited using social media such as Facebook and Twitter, in addition to the cooperation of health personnel contacted with the collaboration of medical scientific societies. A cross-sectional study was carried out that included the response of an online questionnaire. The data were collected from April 30 to September 26, 2021. To assess the different associations between variables to be measured, we fit Poisson regression models with robust variance. RESULTS Responses were obtained from 3,850 adults from the general population group and 502 health professionals. Of the overall sample, 48.6% of participants from the general population were vaccinated against COVID-19, whereas in the healthcare professionals, 94.8% were vaccinated. The prevalence of general population vaccination increased with age, and was higher in women than men. Most participants did not show a preference for any vaccine itself. However, the prevalence of people vaccinated with their preferred vaccine was higher for the ones vaccinated with Pfizer's vaccine. 6.5% of the general population reported being reticent to be vaccinated. People from younger age groups, people with lower educational levels and those who were not from a risk group showed greater reluctance to be vaccinated. No gender differences in reluctancy were found. CONCLUSIONS Health professionals were significantly less likely to refuse vaccination even though they had more doubts about the safety and efficacy of vaccines. On the other hand, younger people, those with a lower level of education and those who were not from a risk group were the most hesitant.
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Affiliation(s)
- Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Hans Eguia
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- SEMERGEN New Technologies Working Group, Madrid, Spain
| | - Albert Espelt
- Department of Epidemiology and Public Health, Faculty of Health Sciences of Manresa, Universitat de Vic–Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Bellaterra. Spain
| | - Salvador Macip
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Department of Molecular and Cell Biology, Mechanisms of Cancer and Aging Laboratory, University of Leicester, Leicester, United Kingdom
| | - Marina Bosque-Prous
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Bellaterra. Spain
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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50
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Yoon S, Goh H, Matchar D, Sung SC, Lum E, Lam SSW, Low JGH, Chua T, Graves N, Ong MEH. Multifactorial influences underpinning a decision on COVID-19 vaccination among healthcare workers: a qualitative analysis. Hum Vaccin Immunother 2022; 18:2085469. [PMID: 35687802 PMCID: PMC9621075 DOI: 10.1080/21645515.2022.2085469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 05/28/2022] [Indexed: 12/03/2022] Open
Abstract
COVID-19 vaccination in healthcare workers (HCW) is essential for improved patient safety and resilience of health systems. Despite growing body of literature on the perceptions of COVID vaccines in HCWs, existing studies tend to focus on reasons for 'refusing' the vaccines, using surveys almost exclusively. To gain a more nuanced understanding, we explored multifactorial influences underpinning a decision on vaccination and suggestions for decision support to improve vaccine uptake among HCWs in the early phase of vaccination rollout. Semi-structured interviews were undertaken with thirty-three HCWs in Singapore. Transcribed data was thematically analyzed. Decisions to accept vaccines were underpinned by a desire to protect patients primarily driven by a sense of professional integrity, collective responsibility to protect others, confidence in health authorities and a desire to return to a pre-pandemic way of life. However, there were prevailing concerns with respect to the vaccines, including long-term benefits, safety and efficacy, that hampered a decision. Inadequate information and social media representation of vaccination appeared to add to negative beliefs, impeding a decision to accept while low perceived susceptibility played a moderate role in the decision to delay or decline vaccination. Participants made valuable suggestions to bolster vaccination. Our findings support an approach to improving vaccine uptake in HCWs that features routine tracking and transparent updates on vaccination status, use of institutional platforms for sharing of experience, assuring contingency management plans and tailored communications to emphasize the duty of care and positive outlook associated with vaccination.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - David Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA
| | - Sharon C. Sung
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Elaine Lum
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sean Shao Wei Lam
- Duke-NUS Medical School, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
| | - Jenny Guek Hong Low
- Duke-NUS Medical School, Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus EH Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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