COVID-19 vaccination intention and vaccine characteristics influencing vaccination acceptance: a global survey of 17 countries

How Technology, Health Information Seeking, and Socioeconomic Factors Are Associated With Coronavirus Disease 2019 Vaccination Readiness in Estonians Over 50 Years?

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

Vaccination homophily in ego contact networks during the COVID-19 pandemic

Vaccine hesitancy is an inevitable risk for societies as it contributes to outbreaks of diseases. Prior research suggests that vaccination decisions of individuals tend to spread within social networks, resulting in a tendency to vaccination homophily. The clustering of individuals resistant to vaccination can substantially make the threshold necessary to achieve herd immunity harder to reach. In this study, we examined the extent of vaccination homophily among social contacts and its association with vaccine uptake during the COVID-19 pandemic in Hungary using a contact diary approach in two cross-sectional surveys. The results indicate strong clustering among both vaccinated and unvaccinated groups. The most powerful predictor of vaccine uptake was the perceived vaccination rate within the egos' social contact network. Vaccination homophily and the role of the interpersonal contact network in vaccine uptake were particularly pronounced in the networks of close relationships, including family, kinship, and strong social ties of the ego. Our findings have important implications for understanding COVID-19 spread dynamics by showing that the strong clustering of unvaccinated individuals posed a great risk in preventing the spread of the disease.

Unmasking vaccine hesitancy and refusal: a deep dive into Anti-vaxxer perspectives on COVID-19 in Spain

BACKGROUND

At the time of the emergence of COVID-19, denialist and anti-vaccine groups have also emerged and are shaking public confidence in vaccination.

METHODS

A qualitative study was conducted using online focus groups. Participants had not received any doses of vaccination against the disease. A total of five focus group sessions were conducted with 28 participants. They were recruited by snowball sampling and by convenience sampling.

RESULTS

The two major topics mentioned by the participants were adverse effects and information. The adverse effects described were severe and included sudden death. In the case of information, participants reported: (1) consultation of websites on which scientists posted anti-vaccination content; and (2) distrust.

CONCLUSIONS

At a time when anti-vaccine groups pose a major challenge to public health in general, and to COVID-19 vaccination campaigns in particular, this study is a first step towards gaining deeper insight into the factors that lead to COVID-19 vaccine refusal.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association between COVID-19 Booster Vaccination and COVID-19 Outcomes among U.S. Adults

Understanding the association between booster vaccination and COVID-19 outcomes can help strengthen post-pandemic messaging and strategies to increase vaccination and reduce severe and long-term consequences of COVID-19. Using the Household Pulse Survey data collected from U.S. adults from 9 December 2022 to 13 February 2023 (n = 214,768), this study assessed the relationship between COVID-19 booster vaccination and COVID-19 outcomes (testing positive for COVID-19, moderate/severe COVID-19, and long COVID). Disparities were found in COVID-19 outcomes (e.g., testing positive for COVID-19, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics, region of residence, food insecurity status, mental health status, disability status, and housing type. Receipt of a COVID-19 booster vaccination was negatively associated with testing positive for COVID-19 (aOR = 0.75, 95%CI: 0.72,0.79), having moderate/severe COVID-19 (aOR = 0.92, 95%CI: 0.88, 0.97), or having long COVID (aOR = 0.86 (0.80, 0.91)). Even among those who tested positive for COVID-19, those who received the booster vaccine were less likely to have moderate/severe COVID-19 and less likely to have long COVID. Communicating the benefits of COVID-19 booster vaccination, integrating vaccination in patient visits, and reducing access barriers can increase vaccination uptake and confidence for all individuals and protect them against the severe negative outcomes of COVID-19.

Factors affecting motivation for receiving a booster dose of the COVID-19 vaccine among Japanese university students and staff: a cross-sectional questionnaire survey

Understanding the factors that influence people's decisions regarding vaccination is essential to promote vaccination. We aimed to clarify the motivations for receiving booster vaccines. We conducted a paper-based questionnaire distributed during January-February 2022 involving students and faculty staff who received the first COVID-19 vaccination at the mass vaccination program during June-September 2021 at Keio University. A total of 1725 participants were enrolled, and all completed the survey. Among these, 64.9% reported a significant adverse event (AEs) affecting daily life after the second vaccine. "Fear of severe COVID-19 illness" (72.6%) was the most common reason for getting vaccinated, followed by "concern of infecting others" (68.4%) and "fear of COVID-19 infection itself" (68.3%). Television emerged as the most influential source of information (80%), followed by university information (50.2%) and social networking sites (42.8%). Multivariate analysis revealed "fear of severe COVID-19 illness", "fear of COVID-19 infection itself", and "trust in the efficacy and safety of the vaccines in general" were significantly correlated with willingness to receive paid vaccinations. The severity of AEs and source of information were not related to participants' willingness to receive booster vaccinations. Participants with positive reasons for vaccination were more likely to accept a third dose.

Vaccinating without complete willingness against COVID-19: Personal and social aspects of Israeli nursing students and faculty members

Soon after the coronavirus disease 2019 (COVID-19) pandemic outbreak, it became clear that vaccination will be the most useful tool to combat the disease. Despite the apparent safety and efficacy of the developed anti-COVID-19 vaccines, relatively high percentages of the population worldwide refused to get vaccinated, including many health workers and health students. The present cross-sectional study examined the motives, attitudes, and personal characteristics of those who did not get vaccinated against COVID-19 or vaccinated without complete willingness among nursing students and nursing faculty members in Israel (n = 472). Results show that the vast majority of the study participants (97%) received at least one dose of the anti-COVID-19 vaccine. Nearly 37% of the participants indicated that they received the vaccine without complete willingness. As compared to faculty members, nursing students reported lower trust in the efficacy of the vaccine, perceived the COVID-19 pandemic as a health threat to a lesser extent, exhibited lower institutional and personal trust, and had higher levels of posttraumatic stress disorder symptoms. Non-Jewish participants were at risk of vaccinating without complete willingness. These findings underscore the need for developing evidence-based strategies to promote the safety and efficacy of the anti-COVID-19 vaccines in nursing schools.

Willingness to accept monkeypox vaccine and its correlates among men who have sex with men in Southern China: a web-based online cross-sectional study

Background

The May 2022 global outbreak of monkeypox (MPX) poses a threat to the health of men who have sex with men. However, there is limited data on the willingness of MSM to receive monkeypox vaccination in Southern China. This study aimed to assess the knowledge of MPX, concerns regarding MPX, and willingness to receive monkeypox vaccination, as well as their correlates, among MSM in China.

Methods

We conducted a Web-based online survey of MSM in Southern China from August to September 2022. Data were collected on the socio-demographic characteristics, knowledge, worries, concerns regarding MPX and willingness to receive monkeypox vaccination. Multivariate logistic regression was employed to explore the factors associated with willingness to receive monkeypox vaccination.

Results

A total of 1903 participants completed the survey. Among them, approximately 69.9% reported being aware of MPX awareness, 94.1% of the participants supported the promotion of monkeypox vaccination. The majority of participants (91.4%) expressed their willingness to receive monkeypox vaccination. Participants who considered monkeypox vaccination safe [adjusted odds ratio (aOR) = 4.82, 95% CI: 1.35-17.18], agreed on the necessity of government promotion of monkeypox vaccination in China (aOR = 6.03, 95% CI: 1.07-33.93), believed in prioritizing monkeypox vaccination for MSM (aOR = 5.01, 95% CI: 1.10-22.71), and had friends or sexual partners who had already received the monkeypox or smallpox vaccination (aOR = 10.37, 95% CI: 2.11-50.99) are more likely to be vaccinated. Conversely, married individuals (aOR = 0.13, 95% CI: 0.03-0.47), those engaging in anal sex 4-6 times per week in the past 3 months (aOR = 0.26, 95% CI: 0.09-0.77) expressed hesitancy toward monkeypox vaccination.

Conclusion

There was a high willingness to receive monkeypox vaccination among MSM in China. The hesitancy toward the monkeypox vaccine can be effectively mitigated by addressing concerns about its safety and potential adverse reactions. Moreover, increasing acceptance of the monkeypox vaccination among MSM and their peers is crucial, as social influence significantly impacts vaccine attitudes and behaviors.

Non-vaccination of dogs is linked to uncompleted COVID-19 vaccination protocols of owners

Despite the known importance of vaccines as one of the greatest achievements in medical science, vaccine hesitancy has been increasing in the last decade and has become a major threat to global health. The growth of vaccine hesitancy worldwide became more evident with the onset of COVID-19 and raised the fear that this hesitancy would also impact companion animal vaccination. This study aimed to characterize vaccine-hesitant groups regarding companion animals and human vaccinations, as well as to explore the possible association between vaccine hesitancy in pets and their owners. An anonymous online survey containing 27 closed questions was conducted, including questions about dog health, such as vaccination, neutering, and homeopathy use, as well as questions about the COVID-19 vaccination status of the owner and motivations for vaccinating or not vaccinating their pets. Most participants (81.5 %) reported receiving three or more doses of the COVID-19 vaccine. Not vaccinating against COVID-19 or having an incomplete vaccination protocol was associated with an increase in the age range of participants (odds ratio [OR] = 1.43), not having higher education (OR = 7.70), and being in extreme income ranges (less than two minimum wages [OR = 7.57] and more than 10 [OR = 5.20]). The use of homeopathy in humans (OR = 3.24) and dogs (OR = 3.74) was associated with non-vaccination against COVID-19. Owners who were not fully vaccinated against COVID-19 were almost six times more likely to not vaccinate their dogs (OR = 5.94). Non-vaccination of dogs was also associated with non-neutering (OR = 3.56), keeping the dog in contact with other dogs (OR = 2.09), and an increase in the number of dogs in the house increased the chance of not vaccinating the animals (OR = 1.30). The present study revealed a strong association between non-vaccination against COVID-19 and non-vaccination in companion dogs, raising the hypothesis that vaccination hesitancy is a growing challenge in veterinary medicine. In addition, the characteristics of Brazilians who are reluctant to be vaccinated against COVID-19 or immunize their companion animals are described here for the first time.

Spatiotemporal trends in COVID-19 vaccine sentiments on a social media platform and correlations with reported vaccine coverage

Objective

To assess spatiotemporal trends in, and determinants of, the acceptance of coronavirus disease 2019 (COVID-19) vaccination globally, as expressed on the social media platform X (formerly Twitter).

Methods

We collected over 13 million posts on the platform regarding COVID-19 vaccination made between November 2020 and March 2022 in 90 languages. Multilingual deep learning XLM-RoBERTa models annotated all posts using an annotation framework after being fine-tuned on 8125 manually annotated, English-language posts. The annotation results were used to assess spatiotemporal trends in COVID-19 vaccine acceptance and confidence as expressed by platform users in 135 countries and territories. We identified associations between spatiotemporal trends in vaccine acceptance and country-level characteristics and public policies by using univariate and multivariate regression analysis.

Findings

A greater proportion of platform users in the World Health Organization's South-East Asia, Eastern Mediterranean and Western Pacific Regions expressed vaccine acceptance than users in the rest of the world. Countries in which a greater proportion of platform users expressed vaccine acceptance had higher COVID-19 vaccine coverage rates. Trust in government was also associated with greater vaccine acceptance. Internationally, vaccine acceptance and confidence declined among platform users as: (i) vaccination eligibility was extended to adolescents; (ii) vaccine supplies became sufficient; (iii) nonpharmaceutical interventions were relaxed; and (iv) global reports on adverse events following vaccination appeared.

Conclusion

Social media listening could provide an effective and expeditious means of informing public health policies during pandemics, and could supplement existing public health surveillance approaches in addressing global health issues.

Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey

Health behavior theories have been effectively used for studying populations' awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants' age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups.

Behavioural and social drivers of COVID-19 vaccination in Vietnam: a scoping review

BACKGROUND

Understanding of the behavioural and social drivers (BeSD) of vaccination is key to addressing vaccine hesitancy and accessibility issues. Vietnam's national COVID-19 vaccination programme resulted in high uptake of primary doses among adults, but lower booster doses for adults and primary doses for 5-11 years. This scoping review assessed BeSD influencing COVID-19 vaccine uptake in Vietnam to design interventions on reaching the national vaccination targets.

METHOD

We conducted a scoping review by searching PubMed, MedRxiv, LitCOVID, COVID-19 LOVE platform, WHO's COVID-19 research database and seven dominant Vietnamese language medical journals published in English or Vietnamese between 28 December 2019 and 28 November 2022. Data were narratively synthesised and summarised according to the four components of the WHO BeSD framework. The drivers were then mapped along the timeline of COVID-19 vaccine deployment and the evolution of the pandemic in Vietnam.

RESULTS

We identified 680 records, of which 39 met the inclusion criteria comprising 224 204 participants. Adults' intention to receive COVID-19 vaccines for themselves (23 studies) ranged from 58.0% to 98.1%. Parental intention to vaccinate their under 11-year-old children (six studies) ranged from 32.8% to 79.6%. Key drivers of vaccination uptake were perceived susceptibility and severity of disease, perceived vaccine benefits and safety, healthcare worker recommendation, and positive societal perception. Commonly reported COVID-19 vaccines' information sources (six studies) were social and mainstream media (82%-67%), television (72.7%-51.6%) and healthcare workers (47.5%-17.5%). Key drivers of COVID-19 uptake remained consistent for both adults and children despite changes in community transmission and vaccine deployment.

CONCLUSION

Key enablers of vaccine uptake for adults and children included perceived disease severity, perceived vaccine benefits and safety and healthcare worker recommendations. Future studies should assess vaccine communication targeted to these drivers, national policies and political determinants to optimise vaccine uptake.

COVID-19 vaccine hesitancy between family decision-makers and non-decision-makers among college teachers

BACKGROUND

Teachers with high educational levels significantly impact the health-related knowledge and attitudes of young students and their family members. This study aimed to investigate the coronavirus disease 2019 (COVID-19) vaccine hesitancy and associated factors, and compare the differences between decision-makers and non-decision-makers among college teachers.

METHODS

A cross-sectional online survey was administered across mainland China from 4 to 7 August 2021. Overall, 251 college teachers were included using snowball sampling. A multivariable logistic regression model was applied to explore the association between decision-makers and hesitancy to receive a COVID-19 vaccine.

RESULTS

Overall, 42.2% of the teachers were hesitant to being vaccinated against COVID-19. The hesitancy rate was lower among primary decision-makers than that among non-decision-makers (34.8% vs. 60.3%, p < .001). Primary decision-makers were less hesitant regarding COVID-19 vaccination than non-decision-makers (OR = 0.37, 95% CI 0.20-0.70); remarkably, whereas those engaged in nursing education versus non-medical related professional education (OR = 2.67, 95% CI 1.29-5.49), and partial versus full-course vaccination recipients (OR = 4.48, 95% CI: 1.76-11.42) were more likely to be hesitant regarding COVID-19 vaccination.

CONCLUSION

Our findings indicate that a high proportion of college teachers in China are hesitant to receiving COVID-19 vaccination, and that primary decision-makers are less likely to exhibit hesitancy to being vaccinated against COVID-19 than non-decision-makers in their family. Family decision-makers among teachers can be considered a priority for COVID-19 vaccine promotion, thereby enhancing vaccine acceptance among vulnerable populations-including older adults and children-and preventing adverse outcomes.KEY MESSAGESQuestion: How prevalent is COVID-19 vaccine hesitancy among college teachers? Do differences exist between decision-makers and non-decision-makers?Findings: We found that a substantial proportion of college teachers are hesitant to being vaccinated against COVID-19, and that family decision-makers exhibited a lower hesitancy rate than non-decision-makers.Meaning: Our findings indicate that distinguishing between family decision-makers and non-decision-makers is necessary to facilitate vaccination promotion interventions among college teachers.

Relationship Between Fear of COVID-19, Conspiracy Beliefs About Vaccines and Intention to Vaccinate Against COVID-19: A Cross-National Indirect Effect Model in 13 Latin American Countries

The present study explored the predictive capacity of fear of COVID-19 on the intention to be vaccinated against COVID-19 and the influence in this relationship of conspiracy beliefs as a possible mediating psychological variable, in 13 Latin American countries. A total of 5779 people recruited through non-probabilistic convenience sampling participated. To collect information, we used the Fear of COVID-19 Scale, Vaccine conspiracy beliefs Scale-COVID-19 and a single item of intention to vaccinate. A full a priori Structural Equation Model was used; whereas, cross-country invariance was performed from increasingly restricted structural models. The results indicated that, fear of COVID-19 positively predicts intention to vaccinate and the presence of conspiracy beliefs about COVID-19 vaccines. The latter negatively predicted intention to vaccinate against COVID-19. Besides, conspiracy beliefs about COVID-19 vaccines had an indirect effect on the relationship between fear of COVID-19 and intention to vaccinate against COVID-19 in the 13 countries assessed. Finally, the cross-national similarities of the mediational model among the 13 participating countries are strongly supported. The study is the first to test a cross-national mediational model across variables in a large number of Latin American countries. However, further studies with other countries in other regions of the world are needed.

How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries

OBJECTIVES

This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.

METHODS

This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.

RESULTS

On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.

CONCLUSIONS

Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

The disease or the vaccination: Which is more important when deciding whether to vaccinate?

RATIONALE

Vaccinations provide adequate protection against many virus-related diseases. Nonetheless, many individuals refuse voluntary vaccinations, and their refusal could contribute to the spread of diseases. Previous research on the intention to vaccinate has been limited by focusing on a single target group.

OBJECTIVE

In this study, we develop an integrated theoretical framework incorporating the dual approach with relevant theories related to both disease and vaccination. Our objective is to examine the behavioral reasons for the decision to vaccinate or not. The vaccination-related appraisals concern aspects of vaccination and the disease-related appraisals concern aspects of COVID-19. The framework is applied to the much-discussed context of COVID-19 vaccination.

METHOD

We investigate the intention to vaccinate of two target groups, unvaccinated individuals and twice-vaccinated individuals, with a partial squares structured equation model.

RESULTS

Our results show that unvaccinated individuals are driven in their intention to vaccinate by their attitude (toward vaccination); factors relating to the disease have no impact. In contrast, when deciding whether to be revaccinated, twice-vaccinated individuals balance factors relating to vaccination and factors relating to disease.

CONCLUSIONS

We conclude that the proposed integrated theoretical model is appropriate for investigating diverse target groups and deriving implications.

Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study

BACKGROUND

COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult.

OBJECTIVE

This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations.

METHODS

The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models.

RESULTS

Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy.

CONCLUSIONS

The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy.

Examining thematic and emotional differences across Twitter, Reddit, and YouTube: The case of COVID-19 vaccine side effects

Social media discourse has become a key data source for understanding the public's perception of, and sentiments during a public health crisis. However, given the different niches which platforms occupy in terms of information exchange, reliance on a single platform would provide an incomplete picture of public opinions. Based on the schema theory, this study suggests a 'social media platform schema' to indicate users' different expectations based on previous usages of platform and argues that a platform's distinct characteristics foster distinct platform schema and, in turn, distinct nature of information. We analyzed COVID-19 vaccine side effect-related discussions from Twitter, Reddit, and YouTube, each of which represents a different type of the platform, and found thematic and emotional differences across platforms. Thematic analysis using k-means clustering algorithm identified seven clusters in each platform. To computationally group and contrast thematic clusters across platforms, we employed modularity analysis using the Louvain algorithm to determine a semantic network structure based on themes. We also observed differences in emotional contexts across platforms. Theoretical and public health implications are then discussed.

COVID-19 vaccination and governance in the case of low, middle and high-income countries

BACKGROUND

Global crises, regardless of the place where they started to spread or of the factors that triggered them, require a comprehensive approach, primarily based on good communication, cooperation and mutual support. No individual and no institution should remain indifferent to crises but, on the contrary, be fully aware that any involvement in curbing them matters. Although humanity can be affected by various types of crises, in this paper we refer to the one related to COVID-19 pandemic. There are certain reasons that come to justify our choice: first of all, being a shock with a strong impact on people, its analysis should be performed from several angles; this may bring to light an image with its disparate propagation and measures to counteract it both in developed countries, and especially in those with a shortage of resources. Secondly, in the context of the emergence of vaccines against COVID-19, it is helpful to have an overview of COVID-19 through the lens of the relationship between the vaccination process and the elements that characterize governance, with a differentiated dashboard by country categories worldwide: low, middle and high-income countries. Our study is far from capturing the complexity arising from such social problem, but rather aims to outline the defining role of governance when it comes to providing firm reactions to the COVID-19 crisis.

METHODS

Given that our sample consists of a large number of countries, namely 170, first, examined all together, and then, split into three groups (high, middle and low-income), it is challenging to address governance in association with COVID-19 vaccination, in order to see how much they interact and how each of the six aggregate governance indicators of the World Bank (Worldwide Governance Indicators) is reflected in this process. Even if they do not oscillate strongly over relatively short periods of time, reporting on health issues requires a sequential inventory, considering closer time intervals, so as to be able to act promptly. Thus, to better distinguish how the COVID-19 vaccination process evolved in low, middle and high-income countries, but also how it was imprinted by governance, we present the situation quarterly (March, June, September and December), in 2021, the year when the immunization campaigns were the most intense at the global level. Regarding the applied methods, we mention both OLS regressions with robust estimators and a panel model, used to investigate the determinants of COVID-19 vaccination, some of them describing the good governance, as well as other dimensions.

RESULTS

The findings point out that the influence of governance on COVID-19 vaccination differs depending on whether a country belongs to high, middle or low-income typology: the strongest determinism of governance on vaccination is encountered in high-income countries, and the weakest in low-income ones; in some cases, governance does not matter significantly. However, exploring the three groups of states included in the research, it is observed that the most relevant factors in this relationship are government effectiveness, regulatory quality and control of corruption.

CONCLUSIONS

Besides the order of importance of governance indicators on COVID-19 vaccination, our study indicates that, overall, governance positively shapes the vaccination rate at the level of the chosen sample. In normative terms, these findings can be translated particularly by the fact that they can serve as information to raise awareness on the relevance of the existence of an institutional framework that allows the formulation of strategies according to the patterns of each country, especially since the actionable tools depend on the available resources. As a general conclusion, public policies should be designed in such a way as to strengthen trust in vaccination regulations and in governments, to reduce the multifaceted negative effects of this health crisis and to hope for its total end.

Psychosocial factors associated with the intention to get a COVID-19 booster vaccine: evidence from a low-income country

Aim

To identify psychosocial predictors of the intention to get a booster COVID-19 vaccine in a low-income country, given that increasing booster vaccination rates against COVID-19 remains a global challenge, especially among low- and middle-income countries (LMIC).

Subject and methods

We used an online survey to collect responses from a non-probabilistic sample of 720 Bolivians regarding vaccine uptake, motives, perceived confidence, information sources, attitudes favouring COVID-19 vaccines, biosafety behaviour, and sociodemographic characteristics. Descriptive, bivariate, and multivariate analyses were performed to identify significant associations and predictors.

Results

We found that having already received the third dose, obtaining recommendations from family or friends, recommendation from the government, perceived confidence in the previously received dose, and higher attitudes in favour of COVID-19 vaccines significantly predicted the intention to get a booster dose. The associations were significant even when adjusting the model for sociodemographic variables.

Conclusion

Including certain psychosocial factors could enhance the promotion of voluntary booster doses among residents of low- and middle-income countries such as Bolivia, where cultural, social, political, and contextual variables may influence health behaviour and increase health-associated risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01937-x.

Acceptance of COVID-19 Vaccines in India: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to evaluate the acceptability levels for COVID vaccine(s) in various states in India. Published articles in PubMed/Scopus/Cochrane/DOAJ/the Web of Science that focused on assessing COVID-19 vaccine hesitation/vaccine acceptance using a survey/questionnaire were included. After extensive research, 524 records were found, and after screening on the basis of eligibility criteria, only 23 papers were added to this review. Increased vaccine assumption percentage (>70%) among the population was found in two surveys nationwide (92.8%) and in Delhi (79.5%). For pooled estimates of COVID-19 vaccine acceptance and heterogeneity, twenty-three studies (23) consisting of 39,567 individuals reported for acceptance of COVID 19 vaccine in India.. Out of these, 26,028 individuals accepted the COVID-19 vaccine, giving a pooled estimate of 62.6% (95% CI: 55.6-69.4) with considerable heterogeneity (χ² = 3397.3, p < 0.0001; I² = 99.40%). The results of this study give a brief insight into the percentage acceptance and hesitancy among the Indian population regarding COVID-19 vaccine immunisation. Future research and vaccine education initiatives can be steered by the findings of this work as a starting point.

A scoping review on the decision-making dynamics for accepting or refusing the COVID-19 vaccination among adolescent and youth populations

BACKGROUND

Global COVID-19 vaccinations rates among youth and adolescent populations prove that there is an opportunity to influence the acceptance for those who are unvaccinated and who are hesitant to receive additional doses. This study aimed to discover the acceptance and hesitancy reasons for choosing or refusing to be vaccinated against COVID-19.

METHODS

A scoping review was conducted, and articles from three online databases, PubMed, Wiley, and Cochrane Library, were extracted and screened based on exclusion and PICOs criteria. A total of 21 studies were included in this review. Data highlighting study attributes, characteristics, and decision-making dynamics were extracted from the 21 studies and put into table format.

RESULTS

The results showed that the primary drivers for accepting the COVID-19 vaccine include protecting oneself and close family/friends, fear of infection, professional recommendations, and employer obligations. Primary hesitancy factors include concerns about safety and side effects, effectiveness and efficacy, lack of trust in pharmaceuticals and government, conspiracies, and perceiving natural immunity as an alternative.

CONCLUSIONS

This scoping review recommends that further research should be conducted with adolescent and youth populations that focus on identifying health behaviors and how they relate to vaccine policies and programs.

COVID-19 Anti-Vaccine Sentiments in Malaysia: Narratives of Comments from Facebook Post

The anti-vaccination movement was an ongoing issue in Malaysia, a Muslim-majority country, even before the COVID-19 pandemic. It is unclear whether the introduction of new COVID-19 vaccines would similarly provoke anti-vaccine sentiments. This study analyzed COVID-19 anti-vaccine sentiments in the Malaysian community. Anti-vaccine comments from Facebook page posts were extracted. The qualitative software QSR-NVivo 10 was used to manage, code and analyze the data. The fast-track COVID-19 vaccine evoked the fear of unknown long-term effects, safety, effectiveness and the duration of protection. The halal status of the COVID-19 vaccines is important. Although it is permissible to use vaccines that are not certified halal under the state of darurah (emergency), there was doubt that the current state has reached the stage of darurah that warrants the use of vaccines. COVID-19 vaccine microchip conspiracy theories were raised. COVID-19 is viewed as only severe for vulnerable populations, and hence vaccination is not needed for the healthy. There were opinions that coronavirus treatments would be more beneficial than vaccination. The anti-COVID-19 vaccine sentiments uncovered in this study provide important insights for the formulation of public health messages to instill confidence in new COVID-19 vaccines. Despite the pandemic being nearly over and many people worldwide having received COVID-19 vaccines, the findings provide important insight into potential issues regarding the introduction of new vaccines in the event of future pandemics.

Prevalence of SARS-CoV-2 infection among urban cleaning and solid waste management workers during transmission of the Omicron variant in Brazil

This study estimated the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in urban cleaning and solid waste management workers during the transmission of the Omicron variant in one of the poorest regions of Brazil (the state of Sergipe). Nasopharyngeal swabs were collected from 494 workers, and the presence of SARS-CoV-2 RNA was tested by quantitative reverse-transcriptase polymerase chain reaction. Data on socio-demographic characteristics, comorbidities, vaccination status, mask use, and use of public transport to commute to the workplace were collected. The prevalence with a 95% confidence interval (CI) was calculated from the proportion of SARS-CoV-2 positive cases among the total number of individuals tested. The prevalence ratio (PR) with a 95% CI was the measure of association used to evaluate the relationship between SARS-CoV-2 infection and the exposure variables. The prevalence of SARS-CoV-2 infection was 22.5% (95% CI, 19.0 to 26.4). Individuals under the age of 40 had a higher prevalence of infection (PR, 1.53; 95% CI, 1.03 to 2.30) as well as those who did not believe in the protective effect of vaccines (PR, 1.78; 95% CI, 1.05 to 2.89). Our results indicate the need for better guidance on preventive measures against coronavirus disease 2019 among urban cleaning and solid waste management workers.

Global pattern and determinants of coronavirus disease 2019 (COVID-19) vaccine coverage and progression: a global ecological study

Background

Understanding and minimizing existing global coronavirus disease 2019 (COVID-19) vaccination disparities is critical to global population health and eliminating health inequities. The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies.

Methods

COVID-19 vaccination coverage data from 206 countries used in the study were derived from "Our World in Data" website. After obtaining the vaccination coverage indicators, we fitted the progression indicators for vaccination. Correlation and multiple linear regression analysis were used to examine the effects of GDP per capita, Gini index, education, and their interactions on the coverage and progression of the COVID-19 vaccination.

Results

The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses for total number of doses, from less than 15% to more than 75% for proportion of people vaccinated, from less than 15% to more than 60% for proportion of people fully vaccinated. Similarly, the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses, from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated, and from less than 0.1 to more than 0.4 for progression of proportion of people fully vaccinated. GDP per capita and education were positively associated with the coverage and progression, while Gini index was negatively associated with the coverage and progression. Negative interaction between GDP per capita and education was also observed for coverage (β = -0.012 to -0.011, P < 0.05) and progression (β = -0.012 to -0.011, P < 0.05).

Conclusions

Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination. Economy and education are two important factors contributing to the disparities. Different countries may adopt varied strategies to promote the national distribution and vaccination of COVID-19 vaccines.

Barriers and Facilitators to COVID-19 Vaccine Uptake among Polish Patients: A Qualitative Interview Study

The decision to receive a COVID-19 vaccine is influenced by a variety of individual and contextual factors. However, there are very few studies that analyse individual vaccination decisions using a qualitative methodology. To close this gap, we conducted a qualitative interview study to examine the opinions and experiences with the vaccine among patients previously hospitalized due to COVID-19, including barriers and facilitators to vaccine uptake. An exploratory qualitative study, using semi-structured telephone interviews, was conducted among 22 patients admitted for COVID-19 in Poland in 2022. Opinions of patients previously hospitalized with COVID-19 on vaccination were varied. Barriers to COVID-19 vaccine uptake stemmed from concerns about vaccine safety, patients' religious beliefs, and negative stories. High disease severity and anxiety over personal and family health were important arguments in favour of receiving the COVID-19 vaccine. The study findings indicated the need for ongoing health education by healthcare staff as well as coordination and integration of multi-sectoral institutional measures regarding COVID-19 prevention strategies as well as increased public health initiatives on social media and engagement of community leaders for awareness about vaccines and vaccination. It is crucial to build trust in COVID-19 vaccinations among the general public by disseminating reliable information through trustworthy and credible sources. However, it ought to be emphasised that, regardless of the measures taken, some individuals will remain unconvinced about receiving a COVID-19 vaccine.

Acceptance and Preference for COVID-19 Vaccine among Japanese Residents at Early Stage of the Epidemic in Japan

Background: This study aimed to survey the attitudes toward COVID-19 vaccines and their acceptability among the Japanese public as soon as the United States Food and Drug Administration (FDA) authorized vaccines and their rollouts started around the world. Methods: An anonymous cross-sectional survey was conducted in Japan between 4 January and 5 March 2021. A questionnaire was administered to evaluate attitudes toward COVID-19 vaccines according to demographic characteristics, vaccine characteristics, and vaccine production. Results: A total of 1037 completed responses were received. More than half (63.5%) of the participants responded positively (extremely likely/likely) toward COVID-19 vaccines. The highest acceptance to be vaccinated was discovered among the youngest age group. As expected, participants who had never delayed acceptance or refused the vaccine in their history of vaccination had a significantly higher willingness to be vaccinated against COVID-19 (p < 0.001). Females (OR = 2.66, 95% CI: 1.99−3.58) and participants who had ever delayed acceptance or refuse the vaccine (OR = 3.49, 95% CI: 2.42−5.05) had higher odds of COVID-19 vaccine hesitancy. Participants with a postgraduate degree (OR = 0.64, 95% CI: 0.40−1.00) presented the highest willingness to be vaccinated against COVID-19. More than two-thirds (72.9%, 95% CI: 70.4%−75.8%) of the participants did not mind a booster dose required following primary vaccination. A total of 63.2% (95% CI: 60.0%−66.0%) of the participants only accepted a nearly 90% effective or above vaccine at preventing COVID-19. At the same, 86.4% (95% CI: 84.4%−88.4%) of the participants reported only accepting a vaccine with minor side effects. Conclusions: The moderate levels of COVID-19 vaccine acceptance found in the early phase of the pandemic demonstrate that it is important to improve the implementation of effective management for vaccine promotion and the acceptability of the vaccine to slow or delay transmission.

Uptake of Heterologous or Homologous COVID-19 Booster Dose and Related Adverse Events Among Diabetic Patients: A Multicenter Cross-Sectional Study - China, 2022

What is already known about this topic?

Although a third coronavirus disease 2019 (COVID-19) vaccination (booster) dose is highly recommended for diabetic patients, the vaccination behaviors and related adverse events are unclear among diabetic patients with a COVID-19 booster dose.

What is added by this report?

Diabetic patients with higher postprandial blood glucose, worrying about the safety of the booster dose were less likely to get the vaccine. While having positive attitudes towards COVID-19 booster vaccination, trusting the health professionals' advice on vaccination, diabetic patients were more likely to get the booster vaccine. Furthermore, the prevalence of adverse events was not significantly different between the homologous and heterologous boosting groups.

What are the implications for public health practice?

Effective measures should be taken to promote the COVID-19 booster dose uptake among diabetic patients. Health professionals should educate Chinese diabetic patients about the safety and efficacy of booster doses and continue to increase the COVID-19 booster dose vaccination coverage.

Global caregiver perspectives on COVID-19 immunization in childhood cancer: A qualitative study

Introduction

SARS-CoV-2 has led to an unprecedented pandemic where vulnerable populations, such as those with childhood cancer, face increased risk of morbidity and mortality. COVID-19 vaccines are a critical intervention to control the pandemic and ensure patient safety. This study explores global caregiver's perspectives related to COVID-19 immunization in the context of pediatric cancer management.

Methods

A mixed methods survey was developed based on consensus questions with iterative feedback from global medical professional and caregiver groups and distributed globally to caregivers of childhood cancer via electronic and paper routes. We present qualitative findings through inductive content analysis of caregiver free-text responses.

Results

A total of 184 participants provided qualitative responses, 29.3% of total survey respondents, with a total of 271 codes applied. Codes focused on themes related to safety and effectiveness (n = 95, 35.1%), logistics (n = 69, 25.5%), statements supporting or opposing vaccination (n = 55, 20.3%), and statements discussing the limited availability of information (n = 31, 11.4%). Within the theme of safety and effectiveness, safety itself was the most commonly used code (n = 66, 24.4% of total segments and 69.5% of safety and effectiveness codes), followed by risks versus benefits (n = 18, 18.9% of safety and effectiveness codes) and efficacy (n = 11, 11.6%).

Discussion

This study provides insights to guide healthcare professionals and caregiver peers in supporting families during the complex decision-making process for COVID-19 vaccination. These findings highlight the multidimensionality of concerns and considerations of caregivers of children with cancer regarding COVID-19 vaccination and suggest that certain perspectives transcend borders and cultures.

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic’s vast impact. Data were collected using a questionnaire designed according to the “survey tool and guidance” provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities’ recommendations, being informed by HCWs or formal information sources, care for others, concern about the country’s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.

Health behaviors are largely not predictive of adverse events following influenza vaccination

BACKGROUND

Identifying health behaviors associated with adverse events following immunization (AEFI) could identify intervention targets for AEFI prevention.

METHODS

University employees receiving an influenza vaccination (n = 1301) completed a series of online surveys for health behaviors including sleep, exercise, dietary intake, and smoking habits, and emotional state (baseline), and for indications of AEFI (three days post-vaccination) and influenza-like illness (ILI) symptoms (fortnightly follow-up for 4 months).

RESULTS

29.9% of participants reported an AEFI and 46.0% reported experiencing ILI during follow-up. Multivariate logistic regression revealed usual sleep duration was associated with AEFI (odds ratio 1.20, 95% confidence interval 1.03-1.41), increasing with each hour of sleep. ILI was associated with reporting AEFI (1.70, 1.24-2.33), increasing BMI (1.03, 1.00-1.06) and survey response frequency (1.13, 1.04-1.22), and decreased with better usual sleep quality (0.96, 0.92-1.00) and with increasing age (0.98, 0.96-1.00). Sex stratification revealed no significant predictors of AEFI for either sex; in women, experiencing AEFI increased likelihood of ILI (1.88, 1.25-2.85) and in men, survey completion frequency increased ILI likelihood (1.19, 1.05-1.36).

CONCLUSIONS

Our study suggests modifying health behaviors would not alter AEFI risk and reactogenicity may signal weaker immunogenicity but confirmation through objective measures is warranted.

Exploring spatiotemporal patterns of COVID-19 infection in Nagasaki Prefecture in Japan using prospective space-time scan statistics from April 2020 to April 2022

Background

Up to April 2022, there were six waves of infection of coronavirus disease 2019 (COVID-19) in Japan. As the outbreaks continue to grow, it is critical to detect COVID-19’s clusters to allocate health resources and improve decision-making substantially. This study aimed to identify active clusters of COVID-19 in Nagasaki Prefecture and form the spatiotemporal pattern of high-risk areas in different infection periods.

Methods

We used the prospective space-time scan statistic to detect emerging COVID-19 clusters and examine the relative risk in five consecutive periods from April 1, 2020 to April 7, 2022, in Nagasaki Prefecture.

Results

The densely inhabited districts (DIDs) in Nagasaki City have remained the most affected areas since December 2020. Most of the confirmed cases in the early period of each wave had a history of travelling to other prefectures. Community-level transmissions are suggested by the quick expansion of spatial clusters from urban areas to rural areas and remote islands. Moreover, outbreaks in welfare facilities and schools may lead to an emerging cluster in Nagasaki Prefecture’s rural areas.

Conclusions

This study gives an overall analysis of the transmission dynamics of the COVID-19 pandemic in Nagasaki Prefecture, based on the number of machi-level daily cases. Furthermore, the findings in different waves can serve as references for subsequent pandemic prevention and control. This method helps the health authorities track and investigate outbreaks of COVID-19 that are specific to these environments, especially in rural areas where healthcare resources are scarce.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00921-3.

COVID-19 vaccine acceptance rate and its predictors in Ethiopia: A systematic review and meta-analysis

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I²), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P.

VALUE

0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P.

VALUE

0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P.

VALUE

0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Multi-dimensional psychosocial factors influencing the willingness to receive a COVID-19 vaccine booster: A survey among the public in Mainland China

This study aimed to investigate multi-dimensional psychological and social factors that influence the willingness to receive a COVID-19 vaccine booster in China. A nationwide cross-sectional online survey was conducted between March and April 2022. A total of 6375 complete responses were received. The majority were of age 18 to 40 years old (80.0%) and college-educated (49.2%). In total, 79% responded extremely willing to receive a COVID-19 vaccine booster. By demographics, younger age, females, higher education, and participants with the lowest income reported higher willingness. Having a very good health status (odds ratio [OR] 3.56, 95% confidence interval [CI] 2.92-4.34) and a higher score of vaccine confidence (OR 3.50, 95% CI 2.98-4.11) were associated with an increased willingness to receive a booster shot. Experiencing no side effects with primary COVID-19 vaccination (OR 2.46, 95% CI 1.89-3.20) and higher perceived susceptibility of COVID-19 infection (OR 2.38, 95% CI 1.92-2.95) were also associated with an increased willingness to receive a booster shot. A variety of psychosocial factors, namely having no chronic diseases, lower perceived concern over the safety of a booster shot, higher perceived severity of COVID-19 infection, and a higher level of institutional trust, were also significantly associated with greater willingness to get a booster shot. In conclusion, the present study adds evidence to the significant role of psychosocial factors in predicting COVID-19 vaccine booster acceptance and provides insights to design interventions to increase booster uptake in certain targeted demographic groups.

COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Higher Collective Responsibility, Higher COVID-19 Vaccine Uptake, and Interaction with Vaccine Attitude: Results from Propensity Score Matching

Providing both personal and social benefits, vaccination may be motivated by collective responsibility (CR). Some previous studies have indicated the relationship between CR and vaccination but could not exclude confounding bias and had little knowledge about the boundary conditions. This study aimed to examine the association between CR and COVID-19 vaccine uptake and its boundary conditions in an extended version of the theory of planned behavior. A cross-sectional survey with 608 participants from six tourism satellite industries in Macao was conducted from 28 July 2021 to 20 August of 2021. Respondentss in CR-lower and CR-higher groups were 1:1 paired using propensity score matching (PSM) to control the potential confounding factors. Results showed participants in the CR-higher group reported significantly higher COVID-19 vaccine uptake than those in the CR-lower group (64.7% vs. 49.7%, p = 0.005). Multivariate logistic regression results indicated a positive association between CR and COVID-19 vaccine uptake (p = 0.012, OR = 2.070, 95% CI= 1.174 to 3.650) and its interaction effect with COVID-19 vaccine attitude (p = 0.019, OR = 0.922, 95% CI = 0.861 to 0.987). Spotlight analysis further illustrated that CR was more effective among individuals with a more negative COVID-19 vaccine attitude. These findings may help promote understanding of vaccine hesitancy, and hence optimize vaccination communication strategies during the COVID-19 pandemic.

The effects of family-centered empowerment model on depression, anxiety, and stress of the family caregivers of patients with COVID-19: a randomized clinical trial

BACKGROUND

Taking care of patients with Covid-19 is regarded as a challenging task for family caregivers. Hence, a Family-Centered Empowerment Model (FCEM) should help them achieve greater psychological strength throughout the home healthcare process.

METHODS

This study is a randomized clinical trial with two groups; besides, pre-test and post-test designs were conducted based on the CONSORT checklist from April to July 2020, in Iran. Seventy family caregivers were randomly assigned to FCEM (n = 35) and control (n = 35) groups. Then, four stages of FCEM in four online sessions were provided to the participants of the intervention group via WhatsApp messenger. The procedure started at the patient's discharge and continued for two weeks. The demographic information questionnaire and Depression Anxiety Stress Scale (DASS-21) were employed before and five days after the FCEM sessions to gather the required data.

RESULTS

The sample was made up of 55.8% women and 44.2% men caregivers, with a mean age of 42.5 years. The results demonstrated a substantial difference in the average score of stress (p = 0.023), anxiety (p = 0.003), and depression (p = 0.012).

CONCLUSIONS

The combination of a face-to-face orientation session and online methods of FCEM is likely to lower stress, anxiety, and depression in family caregivers, which can be contributed to the practicability, simplicity, and effectiveness of this home health intervention.

TRIAL REGISTRATION

This study (no. IRCT20180429039463N2 ) was registered in the Iranian Registry of Clinical Trials on 10/04/2020.

The Relationship between Sources of COVID-19 Vaccine Information and Willingness to Be Vaccinated: An Internet-Based Cross-Sectional Study in Japan

Despite considerable interest in the Japanese population in receiving the vaccine for COVID-19 when it first became available, a sizable percentage of people remain unwilling or hesitant to be vaccinated. Concerns among both the vaccinated and the unwilling center on the vaccine’s efficacy and its safety. Thus, this study aimed to identify whether the willingness to receive COVID-19 vaccination is related to the sources of information people use to learn about the vaccine. A cross-sectional study was conducted on 800 participants registered in an Internet research panel across Japan who completed a questionnaire on their sources of information about the vaccine, demographics, and vaccination status. Vaccine willingness/hesitancy and refusal were set as dependent variables in the logistic regression analysis, with sources of vaccine information and other socio-demographic variables set as independent variables. The results of the analysis found that the information sources significantly associated with willingness to vaccinate were TV (AOR 2.44 vs. vaccine refusal/hesitation), summary websites of COVID-19 by non-experts (AOR 0.21, vs. vaccine refusal/hesitation), Internet video sites (AOR 0.33, vs. vaccine refusal/hesitation), and the personal websites of doctors (AOR 0.16, vs. vaccine refusal/hesitation). Given the likelihood of misinformation in non-traditional sources of information, it is important that health communications be accurate and persuasive.

Comparison of IgA, IgG, and Neutralizing Antibody Responses Following Immunization With Moderna, BioNTech, AstraZeneca, Sputnik-V, Johnson and Johnson, and Sinopharm's COVID-19 Vaccines

In an ongoing multinational trial, we obtained blood samples from 365 volunteers vaccinated with mRNA vaccines (Moderna, BioNTech), viral DNA-vectored vaccines (AstraZeneca, Sputnik-V, and Johnson and Johnson), or the attenuated virus vaccine from Sinopharm. After collecting reactogenicity data, the expression of S-Protein binding IgG and IgA was analyzed using an automated sandwich ELISA system. Serum neutralizing potentials were then investigated using an ACE-2-RBD neutralizing assay. Moderna's vaccine induced the highest amounts of SARS-CoV-2 specific neutralizing antibodies compared to the other groups. In contrast, Sinopharm and Johnson and Johnson's vaccinees presented the lowest SARS-CoV-2-specific antibody titers. Interestingly, moderate to high negative correlations between age and virus-specific IgG expression were observed in the Johnson and Johnson (ρ =-0.3936) and Sinopharm (ρ =-0.6977) groups according to Spearman's rank correlation analysis. A negative correlation was seen between age and IgA expression in the Sputnik-V group (ρ =-0.3917). The analysis of virus neutralization potentials in age categories demonstrated that no significant neutralization potential was observed in older vaccinees (61and 80 years old) in the Sputnik-V Johnson and Johnson and Sinopharm vaccinees' groups. In contrast, neutralization potentials in sera of Moderna, BioNTech, and AstraZeneca vaccinees were statistically comparable in all age categories. Furthermore, while the AstraZeneca vaccine alone induced moderate IgG and IgA expression, the combination with Moderna or BioNTech mRNA vaccines induced significantly higher antibody levels than a double dose of AstraZeneca and similar IgG expression and neutralization potential compared to Moderna or BioNTech vaccines used alone. These results suggest that mRNA vaccines are the most immunogenic after two doses. DNA vectored vaccines from AstraZeneca and Sputnik-V presented lower but significant antibody expression and virus neutralizing properties after two doses. The lowest antibody and neutralization potential were observed in the Sinopharm or Johnson and Johnson vaccinees. Especially elderly over 60 presented no significant increase in neutralizing antibodies after vaccination. The data also indicate that heterologous vaccination strategies combining the AstraZeneca DNA vectored vaccines and mRNA vaccines are more effective in the induction of neutralizing antibodies compared to their homologous counterparts.

Design and Cross-Cultural Invariance of the COVID-19 Vaccine Conspiracy Beliefs Scale (COVID-VCBS) in 13 Latin American Countries

Aims

Over the past 2 years, the vaccine conspiracy beliefs construct has been used in a number of different studies. These publications have assessed the determinants and outcomes of vaccine conspiracy beliefs using, in some cases, pooled data from different countries, and compared the results across these contexts. However, studies often do not consider measurement invariance as a necessary requirement for comparative analyses. Therefore, the aim of this study was to develop and evaluate the cross-cultural MI of the COVID-19 Vaccine Conspiracy Beliefs Scale (COVID-VCBS) in 12 Latin American countries.

Methods

Confirmatory factor analysis, item response theory analysis and alignment method were applied to test measurement invariance in a large number of groups.

Results

The COVID-VCBS showed robust psychometric properties and measurement invariance for both factor loadings and crosstabs. Also, a higher level of acceptance of conspiracy beliefs about vaccines is necessary to respond to higher response categories. Similarly, greater acceptance of conspiracy beliefs about COVID-19 vaccines was related to a lower intention to be vaccinated.

Conclusion

The results allow for improved understanding of conspiracy beliefs about COVID-19 vaccines in the countries assessed; furthermore, they provide researchers and practitioners with an invariant measure that they can use in cross-cultural studies in Latin America. However, further studies are needed to test invariance in other countries, with the goal of developing a truly international measure of conspiracy beliefs about COVID-19 vaccines.

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

Patients with cancer have a higher risk of severe coronavirus disease (COVID-19) and associated mortality than the general population. Owing to this increased risk, patients with cancer have been prioritized for COVID-19 vaccination globally, for both primary and booster vaccinations. However, given that these patients were not included in the pivotal clinical trials, considerable uncertainty remains regarding vaccine efficacy, and the extent of humoral and cellular immune responses in these patients, as well as the risks of vaccine-related adverse events. In this Review, we summarize the current knowledge generated in studies conducted since COVID-19 vaccines first became available. We also highlight critical points that might affect vaccine efficacy in patients with cancer in the future.

Intention to receive a COVID-19 vaccine booster dose and associated factors in Malaysia

This study aims to provide evidence of hesitancy in receiving the COVID-19 booster vaccine and associated factors in the vaccinated population that have completed a primary vaccination series. An anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years via social media platforms. A total of 1010 responses were collected, of which 43.0% (95%CI 39.9–46.0) declared a definite willingness to receive a COVID-19 vaccine booster, 38.2% (95%CI 35.2–44.3) reported being somewhat willing and only 5.7% (95%CI 4.5–7.4) reported being definitely unwilling. Demographically younger participants, those of higher income, Chinese ethnicity and those from the central region reported significantly higher odds of a definite willingness to receive the COVID-19 vaccine booster compared to the reference group (somewhat willing/undecided/somewhat unwilling/definitely unwilling). Having no side effects with past COVID-19 vaccination was associated with a significantly higher odds of definite willingness (OR = 2.82, 95% CI 1.33–5.99). A lower (range 6–22) pandemic fatigue score (OR = 2.34, 95% CI 1.75–3.22) and higher (range 24–30) preventive practices score (OR = 2.45, 95% CI 1.80–3.34) were also associated with higher odds of definite willingness. Regarding attitudes toward COVID-19 booster vaccine, having fewer concerns about the side effects of booster vaccination and the uncertain long-term safety of multiple COVID-19 vaccinations were found to create greater odds of a definite willingness to receive the COVID-19 vaccine booster. Findings from this study provided insights into demographic characteristics and important behavioral and attitudinal factors associated with COVID-19 vaccine booster hesitancy.

Key predictors of COVID-19 vaccine hesitancy in Malaysia: An integrated framework

Background

As the vaccination drive against the coronavirus disease (COVID-19) in Malaysia progresses rapidly, the main challenge will gradually shift from procuring and distributing vaccines to ensuring the broadest possible acceptance among all population segments. Therefore, this study used the integrated framework of the health belief model (HBM) and the theory of reasoned action (TRA) to investigate the predictors of intention to receive COVID-19 vaccines in Malaysia.

Methodology

A market research company in Malaysia was engaged to collect data during June 11–20, 2021 using self-administered questionnaires via its online panel, ensuring a nationwide random sample of 804 respondents. A logistic regression was subsequently estimated to determine the significant predictors of vaccination intention.

Results

The predictors that significantly affect COVID-19 vaccine hesitancy in Malaysia are age, susceptibility, religious beliefs, attitude, subjective norms, and trust in the vaccine. In particular, those who are more inclined to get vaccinated are older individuals, have a higher perceived risk of infection and social pressure to get vaccinated, have a positive attitude, and have high levels of trust in the vaccine. Individuals’ who perceive that their religious beliefs are against vaccination are more likely to exhibit uncertainty toward it.

Conclusion

This study showed that although a large proportion of respondents indicated that they were willing to be vaccinated against COVID-19, there are concerns about religious barriers and trust in the vaccine that the relevant stakeholders should address. Campaigns should also focus on shaping the nation’s attitude toward COVID-19 vaccines, in parallel with encouraging people to use their social influence in helping those in their close circle who are unsure of vaccination to cross the line. These measures will prove to be pertinent as the nation begins to administer booster vaccines to tackle the waning effects of COVID-19 vaccines.

COVID-19 Vaccination Hesitancy: A Review of the Literature and Recommendations

Vaccines are important to improve immunity against pathogens and diseases. The current COVID-19 disease is rapidly evolving and spreading among people; therefore, it is important to utilize a proper vaccination strategy against it. Currently, many approved vaccines are available and accessible; however, there is a reported hesitancy against taking them among the public and even the health care workers. Mainly, this is attributed to the fear of the possible side effects and complications. Moreover, inaccurate knowledge disseminated through the media/social media especially by those who lack proper expertise adds confusion and more fear that affects the vaccination decision. For such reasons, it is essential to find strategies to increase the acceptability of vaccines and to enhance confidence in the vaccination process. This should be accompanied by sufficient efforts and proper clinical studies to confirm the value and the safety of the vaccines. Those strategies are important to avoid the further spread of the COVID-19 disease and to abort the pandemic worldwide, especially when considering the likely approach towards a COVID-19 booster vaccination program, in which booster vaccines are re-taken along intervals to adequately contain the rapidly evolving nature of the virus. This review article highlights the factors influencing the acceptability of the COVID-19 vaccination and enrollment in clinical trials among the public and some specific populations. Furthermore, it summarizes the suggested strategies and recommendations that can improve the attitudes towards COVID-19 vaccination programs.