Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage

High coverage and equitable distribution of COVID-19 vaccine uptake in two vulnerable areas in Bangladesh

Bangladesh completed a primary series of COVID-19 vaccinations for about 86 individuals per 100 population as of 5 July 2023. However, ensuring higher coverage in vulnerable areas is challenging. We report on the COVID-19 vaccine uptake and associated factors among adults in two vulnerable areas in Bangladesh. We conducted a cross-sectional study between August and September 2022 in Duaripara, a slum in northeast Dhaka (in-migration site), and Tala, a disaster-prone sub-district in southwest Satkhira (out-migration site). We surveyed 1,239 adults in Duaripara and 1,263 adults in Tala from 625 and 596 randomly selected households, respectively. We reported coverage and examined associations between the uptake and demographic and socioeconomic characteristics using multilevel mixed-effects generalized linear regression models. We checked for spatial autocorrelation to assess geographical patterns in vaccine distribution. First- and second-dose coverage was about 91% and 80.4% in Duaripara and 96.6% and 92.2% in Tala, respectively. Individuals above 40 were more likely to be vaccinated (IRR: 1.12, p-value = 0.04 for Duaripara, and IRR: 1.14, p-value <0.01 for Tala). Professions requiring more outdoor interactions had a higher likelihood of receiving the vaccine. In Tala, television access (IRR: 2.09, p-value <0.01) and micro-credit membership (IRR: 1.50, p-value = 0.05) were positively associated with receiving a booster dose and negatively associated with smart-phone access (IRR: 0.58, p-value = 0.03). Moreover, temporarily migrated respondents were more likely to be unvaccinated (IRR: 0.87, p-value = 0.04). Income was not associated, indicating equitable distribution. Moreover, no geographical clustering was detected. The credit for high COVID-19 vaccine coverage in Bangladesh can be attributed to the country's longstanding success in implementing immunization programs, which relied on community mobilization and effective health education to generate demand. However, to ensure comprehensive coverage in vulnerable areas, targeted interventions can help increase uptake by addressing specific sociodemographic differences.

Determinants of COVID-19 and non-COVID-19 vaccine confidence in low- and middle-income countries: A systematic review of qualitative evidence and thematic synthesis

BACKGROUND

The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs.

METHODS

A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute's Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform.

FINDINGS

66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information.

CONCLUSION

Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.

Spatiotemporal dynamic and regional differences of public attention to vaccination: An empirical study in China

BACKGROUND

Internet searches offer an indicator of public attention and possible demand for certain things. Studying the spatiotemporal characteristics of the public's concern for vaccination can determine the spatiotemporal distribution of demand for vaccines in China, and capture the changes in the health awareness of the Chinese population, thus informing future vaccination strategies.

METHODS

Based on the collection of Baidu search indices for vaccination-related keywords in 363 cities in China, This paper seeks to explore the spatiotemporal changes and regional differences in public attention toward vaccination in China by using the seasonal index, seasonal concentration index, Herfindahl index, Moran index, and Dagum Gini coefficient.

RESULTS

The following findings are presented. First, there are significant seasonal fluctuations and unbalanced monthly distributions of vaccination-related public attention in China. Second, the public attention in Chinese cities shows the spatial characteristics of "leading in the east, followed by the central, western and northeastern regions". The spatial correlation of attention has been strengthened, and the high-high clusters are mainly distributed in the Beijing-Tianjin-Hebei (BTH), Yangtze River Delta (YRD), and Greater Bay Area (GBA) urban agglomerations. Third, regional differences in overall public attention narrowed in China, with intra-regional differences narrowing in seven regions (Northwest China, Central China, and so on), and intra-regional differences increasing in East China. The dominant role in the Gini coefficient changes from transvariation intensity to inter-regional differences.

CONCLUSION

Major public health emergencies stimulate the public's attention to health topics. Although the short-term increase in vaccination-related public attention was not observed to translate into a long-term increase in public vaccine literacy, the seasonal and regional differences in vaccination-related public attention in China have significantly narrowed before and after COVID-19, suggesting that the imbalance between public health literacy levels has improved.

Global COVID-19 vaccine hesitancy among elderly: A systematic review

Background & Objectives

Elderly infected with COVID-19 has high mortality risk, and the protection from COVID-19 vaccine is limited by vaccine hesitancy. The information of vaccine hesitancy in elderly is incomplete and fragmented. In this study, we attempt to examine the level of vaccine hesitancy in elderly and the related factors in global perspectives.

Methods

A systematic review was conducted to include observational studies of COVID-19 vaccine hesitancy in elderly from January 2020 to September 2021. Search strategies covering COVID-19 vaccine, vaccine hesitancy and elderly in four databases of PUBMED, MEDLINE, EMBASE and COCHRANE LIBRARY were adopted. Studies reporting COVID-19 vaccine hesitancy prevalence in elderly were included. A meta-analysis of the vaccine hesitancy prevalence was performed. The primary outcome is the vaccine hesitancy prevalence in elderly population globally. The secondary outcomes are the factors of COVID-19 vaccine hesitancy among elderly.

Results

Initial 479 articles were included for screening, with 54 studies included for meta-analysis of COVID-19 vaccine hesitancy in elderly and 6 studies included for qualitative analysis of factors for vaccine hesitancy. The overall prevalence of vaccine hesitancy was 27.7 % (95 % C.I: 23.8-31.6 %). The prevalence was significantly higher in Asia than in Europe (35.3 % VS 17.9 %, p < 0.05). The vaccine hesitancy was significantly higher before the launch of the vaccine than after (30.3 % VS 18.7 %, p < 0.05). Important factors of vaccine hesitancy in elderly identified were low income, low education, perception of COVID-19 being more contagious, more vaccine side effects and lower vaccine efficacy.

Conclusions

COVID-19 vaccine hesitancy is an important problem in elderly, with geographical variation. Tailored policy and strategies targeting the hesitancy factors were required to promote COVID-19 vaccine to elderly.

A Novel Cell- and Virus-Free SARS-CoV-2 Neutralizing Antibody ELISA Based on Site-Specific Labeling Technology

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the global spread of coronavirus disease 2019 (COVID-19), creating an urgent need for updated methods to evaluate immune responses to vaccines and therapeutic strategies. In this study, we introduce a novel cell-free, virus-free SARS-CoV-2 neutralizing antibody ELISA (NAb-ELISA), which is based on competitive inhibition of the receptor binding domain (RBD) of spike protein binding to the angiotensin-converting enzyme 2 (ACE2) receptor. In this method, site-specific biotinylated hACE2-Fc-Avi recombinant protein is immobilized onto a 96-well plate for capture, and the RBD-Fc-vHRP recombinant proteins serve as detection probes. Evaluation of sera from wild type (WT) or Delta RBD-immunized mice using the NAb-ELISA and pseudovirus neutralization tests (pVNTs) demonstrated strong correlations between assays (R2 = 0.91 and 0.90 for the WT and Delta groups, respectively). Additionally, the NAb-ELISA successfully detected cross-neutralizing activity in sera, though with slightly lower correlation to pVNT (R2 = 0.70-0.83). By employing NAb-ELISA instead of an indirect ELISA for hybridoma screening, five monoclonal antibodies (mAbs) with neutralizing activities against WT, Delta, and BA.2 pseudoviruses were obtained. This assay offers a straightforward, rapid, and safe approach to characterizing vaccine-induced antibody responses and mAb neutralization activity. Notably, the NAb-ELISA platform can be quickly adapted to assess neutralizing antibody responses against emerging mutant strains, addressing the rapid mutation of the virus.

Vaccine Confidence Among Young Adults During COVID-19: A Cross-Sectional Study from Turkey

Purpose

A lack of confidence in vaccination is a threat to public health and undermines vaccine uptake at national and global levels. Unfortunately, COVID-19 vaccine confidence among Turkish young adults is poorly known. This study aims to understand COVID-19 vaccine confidence among Turkish young adults aged 18-29 and the barriers to and facilitators of vaccine uptake.

Methods

The present research is a cross-sectional study. Survey data were collected in May and June 2022 (n = 1066) during the COVID-19 vaccination campaign. Results were expressed in frequencies and percentages for dichotomous variables and mean with standard deviation for continuous variables. To assess COVID-19 vaccine confidence based on selected sociodemographic characteristics, a one-way ANOVA analysis and an independent-sample t-test were used.

Results

Almost half of the sample (43.9%) underestimated the risk of contracting COVID-19 disease. 65.9% of participants believed that getting vaccinated against COVID-19 was important, while 47.8% thought the vaccine was safe and not dangerous or harmful. Concerns about vaccine effectiveness (58.3%) were the primary reported reason for vaccination. The percentage of participants who reported barriers to vaccine access was generally low (8.7%). Importantly, 63.9% believed getting vaccinated is their responsibility to their community. 33.8% of participants reported encountering inaccurate, misleading, and unfavorable information about COVID-19 vaccines, while 22.9% said they were unsure.

Conclusion

Addressing concerns about COVID-19 vaccine safety and efficacy, emphasizing the role of vaccination in societal benefits, ensuring easy access to vaccines, and providing access to up-to-date and accurate information from reliable sources might help increase coverage among young adults. Perhaps the most crucial advice is to instill the correct comprehension of vaccination and make lifelong vaccination a reality before individuals develop false beliefs that are challenging to rectify.

Predicting intentions to receive a COVID-19 booster vaccination among older adults using the Theory of Planned Behavior

The purpose of this study was to use the Theory of Planned Behavior to predict older adults' intentions and related factors of getting COVID-19 booster vaccinations and compare gender differences. A cross-sectional study was conducted, and 147 adults aged 65 years or older were recruited by convenience sampling in Taiwan. Results revealed that 57.1 % of participants had positive intentions of getting a COVID-19 booster vaccination. Attitudes, subjective norms, and perceived behavioral control explained 86.0 % of the behavioral intentions of getting a COVID-19 booster vaccination. Perceived behavioral control was the most important factor, followed by attitudes. Differences in intentions of getting the COVID-19 booster vaccination between males and females were not significant. The Theory of Planned Behavior and its main constructs can be appropriately applied to predict intentions to receive COVID-19 booster vaccinations among older adults.

Dynamic factors associated with COVID-19 vaccine uptake in Cameroon between 2021 and 2022

Background

Little is known about attitudes towards COVID-19 vaccination in sub-Saharan Africa, where immunisation coverage is the lowest in the world.

Aim

The study aimed to identify factors associated with COVID-19 vaccine hesitancy and uptake in Cameroon, and assess changes in these factors over a period of time.

Setting

The study was conducted in the ten regions of Cameroon.

Methods

The authors conducted a two-phase cross-sectional survey in the 10 regions of Cameroon, from July 2021 to August 2021 (Phase one) and from August 2022 to September 2022 (Phase two). We analysed reasons for vaccine hesitancy descriptively and used logistic regression to assess factors associated with hesitancy.

Results

Overall, we enrolled 12 109 participants: 6567 (54.23%) in Phase one and 5542 (45.77%) in Phase two. Of these, 8009 (66.14%) were not interested in receiving the COVID-19 vaccine (n = 4176 in Phase one, n = 3833 in Phase two). The refusal rate increased significantly in the northern region from 27.00% in Phase 1 to 60.00% in Phase two. The leading contributor to COVID-19 vaccine hesitancy was fear that the vaccine was dangerous, which was significantly associated (95% confidence interval [CI], p < 0.05%) with vaccine refusal in both phases. Overall, 32.90% of participants (n = 2578) perceived the COVID-19 vaccine to be dangerous. Advanced age, male gender, Muslim religion and low level of education were associated with vaccine acceptance. Participants reported that healthcare workers were the most trusted source of information about the COVID-19 vaccine by 5005 (42.84%) participants.

Conclusion

Despite the investment of the Ministry of Health and its partners in community engagement, focussing on communication about the vaccine efficacy, tolerance and potential adverse events, fear of the vaccine remains high, likely leading to vaccine hesitancy in Cameroon between 2021 and 2022.

Contribution

The study highlight regional variations in COVID-19 vaccine acceptance in Cameroon, with factors age, gender, religion and education influencing willingness to vaccine. Trust in health workers was high, indicating that, tailored, community-led vaccination strategies are key for improving vaccine uptake, not only for COVID-19 but also for future epidemics.

Vaccine hesitancy in context of COVID-19 in East Africa: systematic review and meta-analysis

BACKGROUND

The outbreak of the SARS-CoV-2 pandemic has had a significant impact on human lives, and the development of effective vaccines has been a promising solution to bring an end to the pandemic. However, the success of a vaccination program heavily relies on a significant portion of the population being vaccinated. Recent studies have indicated a rise in vaccine hesitancy over time and inconsistent factors affecting it. This study aimed to synthesis of the pooled prevalence of COVID-19 vaccine hesitancy and associated factors among various communities in East Africa.

METHODS

The review encompassed relevant descriptive and observational studies conducted between January 1, 2020, and December 26, 2023. We browsed various databases, including PubMed, Google Scholar, Scopus, African online Journal, cross-references, and Web of Science. After extracted and exported to R the data analysis was performed using R version 4.2. Meta-package were used to estimate the pooled prevalence and factors of vaccine hesitancy. Publication bias was assessed through funnel plots, Egger's test, and trim-and-fill methods.

RESULTS

After carefully screening an initial pool of 53,984 studies, a total of 79 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of vaccine hesitancy was 40.40% (95% CI: 35.89%; 45.47%, I2: 99.5%). Identified factors influencing vaccine hesitance were female sex, under 40 years old, inadequate prevention practices, relying on web/internet as a source of information, having a negative attitude towards the vaccine, uncertainty about vaccine safety, fear of adverse effects, uncertainty about contracting COVID-19, and belief in conspiracy myths.

CONCLUSIONS

Approximately four out of ten individuals in this region express hesitancy towards vaccination. A tailored approach that considers the socio-demographic context could significantly reduce this hesitancy. To achieve high vaccination coverage, a comprehensive strategy is essential, necessitating substantial social, scientific, and health efforts. The success of vaccination campaigns within this population relies on the widespread and consistent implementation of effective interventions.

REGISTRATION

Registered in PROSPERO with ID: CRD42024501415.

Parents' Willingness to Vaccinate Their Children Aged From 6 Months to Under 5 Years With COVID-19 Vaccines

Despite strides in vaccinating priority groups against COVID-19, children under 5 years in Vietnam are still under-immunized, emphasizing a significant gap in prioritization. This study aimed to assess parental willingness to vaccinate children aged 6 months to under 5 years against COVID-19 in Vietnam and identify influential factors affecting this willingness. Data were collected via a survey of 5960 parents/guardians between May and June 2022. Multinomial logistic regression was employed to analyze the impact of various factors on parents' willingness to vaccinate their children, alongside investigating reasons for reluctance or refusal and preferences for vaccine origins. Approximately 50.5%, 30.2%, and 19.3% of parents were willing, hesitant, and unwilling to vaccinate their children, respectively. Primary reasons for reluctance included concerns about vaccine safety, efficacy, and the severity of the pandemic. The most preferred vaccines originated in the United States. Factors significantly influencing willingness included parents' age, knowledge of COVID-19 and vaccines, residency, education, perception of information sufficiency, children's comorbidities, and family members' vaccination status. Promoting child vaccination habits can boost COVID-19 immunization rates. Targeting hesitancy among parents of children with comorbidities is crucial. Enhancing parental knowledge and leveraging fully vaccinated family members are effective strategies.

COVID-19 vaccine uptake in individuals with functional difficulty, disability, and comorbid conditions: insights from a national survey in Bangladesh

BACKGROUND

COVID-19 vaccine uptake among individuals with disabilities is crucial for safeguarding their health and well-being. However, the extent of vaccine uptake among this group remains largely unknown in low- and middle-income countries. This study aims to assess the COVID-19 vaccine uptake among persons with functional difficulty, disability and/or comorbidity in Bangladesh and their associated factors.

METHODS

Data from 9,370 respondents extracted from the 2021 National Household Survey on Persons with Disability were analysed. The outcome variable was the uptake of at least one dose of the COVID-19 vaccine (yes, no). Key explanatory variables included the presence of disability (yes, no), comorbidity (yes, no), and both comorbidity and disability (yes, no) among persons with functional difficulty. The relationship between the outcome and explanatory variables was determined using mixed-effects multilevel logistic regressions adjusted for covariates.

RESULTS

The overall uptake of at least one dose of the COVID-19 vaccine among persons with functional difficulty was 57.37%, among persons with functional difficulty and disability was 48.63% and among persons with functional difficulty and single (57.85%) or multi-comorbidity (60.37%). Compared to the respondents with functional difficulty only, the adjusted odds ratio (aOR) of not receiving any dose of the COVID-19 vaccine for individuals with both functional difficulty and disability was 1.37 (95% CI, 1.22-1.53), and for individuals with functional difficulty, disability and one or more comorbid conditions was 1.30 (95% CI, 1.15-1.47). The aOR of receiving at least one dose of the COVID-19 vaccine among individuals with functional difficulty and one or more comorbid conditions was significantly higher than among those with functional difficulty only.

CONCLUSION

In Bangladesh, COVID-19 vaccine uptake was relatively low among individuals with disabilities. The existing COVID-19 vaccine rollout programs and similar future programs should prioritise individuals with disabilities and include targeted strategies to reach them.

Development and Evaluation of Methotrexate and Baicalin-Loaded Nanolipid Carriers for Psoriasis Treatment

Objectives

Psoriasis is a chronic inflammatory, T-lymphocyte immune-mediated skin disease. In this study, skin-permeating nanolipid carriers (NLCs) of Methotrexate (MTX) and Baicalin (BL) were formulated. This further gave formulation of nano-lipid encapsulated carriers for dual-drug delivery of the hydrophilic and hydrophobic drugs through the liposomal gel.

Materials and Methods

Optimization of the formulation of NLCs was performed and characterized by determining their particle size, drug permeation, skin irritation, drug loading capacity, stability, in vitro drug release behavior, and in vitro cellular viability. Ex vivo skin permeation and in vivo psoriatic efficiency were also evaluated and compared.

Results

Results revealed that the amount of MTX permeating the skin was 2.4 to 4.4 fold greater for dual-drug s than for single NLCs. The optimized dual-drug loaded NLCs had an average particle size (150.20 ± 3.57 nm) and polydispersity index (0.301 ± 0.01) and high entrapment (86.32 ± 2.78% w/w). The MTX nanoparticles exhibit a positive Zeta potential of 38.6 mV. The psoriasis area and severity index scoring showed the lowest skin erythema, skin thickness and scaling. MTX-BL NLCs were inhibited the expression of inflammatory cytokines (tumor necrosis factor-alpha, and interleukin-17) .

Conclusion

It can be concluded that newer targeting strategies for NLCs for dual-drug delivery of nano-lipid carriers could be administered topically for the treatment of psoriasis.

COVID-19 vaccination in low and middle-income countries: Creating a sustainable roadmap for promoting public health intervention

The Coronavirus Disease 2019 (COVID-19) pandemic is a global public health threat ravaging the health systems. In low and middle-income countries (LMICs), COVID-19 and several other challenges concurrently worsen the health outcome indicators. Interestingly, vaccines have been identified as the most reliable and cost-effective public health intervention, and the governments in LMICs have instituted an array of plans to ensure every eligible person gets vaccinated. However, there is still considerable apathy around the use of the available COVID-19 vaccines in LMICs which is impeding the fight against the COVID-19 pandemic. In this paper, we explore the multiple interrelated factors behind low COVID-19 vaccination coverage in LMICs. It is therefore recommended that the governments in LMICs embrace multicomponent and wide-ranging strategies. This should involve utilising community-based approaches such as community pharmacy-led vaccination to promote community access to COVID-19 vaccines and to revive trust in national health authorities by offering population-specific, target-driven, transparent, and timely communication to the community who they serve about the safety and efficacy of the COVID-19 vaccine. Communication strategies should be tailored to reflect diverse political orientations as this can enhance vaccine acceptance. Additionally, local political parties and representative should be engaged in broad alliances to facilitate community mobilisation and support for vaccination campaigns. Also, relevant Nongovernmental Organisations and Community-based Organisations should institute programs at the grassroots that incorporate the gatekeepers to the community aimed at influencing population behaviour regarding COVID-19 vaccine hesitancy. Besides, the public health department in the ministry of health in LMICs should create more awareness, through social and mass media, particularly in the rural, semi-urban, and slum communities about the pivotal role of vaccination. Thus, we opined that these strategies will help LMICs achieve the COVID-19 vaccination target and further reposition the healthcare systems, and promote other public health interventions now and in the future.

COVID-19 vaccination intention among internally displaced persons in complex humanitarian emergency context, Northeast Nigeria

Internally displaced persons (IDPs) are at high risk for COVID-19 transmission because of congested and unsanitary living conditions. COVID-19 vaccination is essential to build population immunity and prevent severe disease among this population. We determined the prevalence and factors associated with intention to accept COVID-19 vaccine among IDPs in Northeast Nigeria. This cross-sectional study, conducted during July-December 2022, included 1,537 unvaccinated IDPs from 18 IDPs camps. We performed a complex sample survey analysis and described participants' characteristics and vaccination intention with weighted descriptive statistics. We fitted weighted logistic regression models and computed adjusted odds ratios with 95% confidence intervals to identify factors associated with intention to accept COVID-19 vaccine. Of 1,537 IDPs, 55.4% were 18-39 years old, 82.6% were females, and 88.6% had no formal education. Among them, 63.5% (95% CI: 59.0-68.1) expressed intention to accept COVID-19 vaccine. Among the IDPs who intended to reject vaccine, 42.8% provided no reason, 35.3% had COVID-19 misconceptions, 9.5% reported vaccine safety concerns, and 7.4% felt no need. IDPs who perceived COVID-19 as severe (Adjusted Odds Ratio (AOR) = 2.31, [95% CI: 1.35-3.96]), perceived COVID-19 vaccine as effective (AOR = 4.28, [95% CI: 2.46-7.44]) and resided in official camps (AOR = 3.29, [95% CI: 1.94-5.56]) were more likely to accept COVID-19 vaccine. However, IDPs who resided 2 kilometers or farther from the nearest health facility (AOR = 0.34, [95% CI: 0.20-0.58]) were less likely to accept vaccine. Intention to accept COVID-19 vaccine among the IDPs was suboptimal. To improve vaccination acceptance among this population, health education and risk communication should be intensified to counter misinformation, strengthen vaccine confidence, and shape perception of COVID-19 severity, focusing on IDPs in unofficial camps. Appropriate interventions to deliver vaccines to remote households should be ramped up.

COVID-19 vaccination uptake in remote areas-Evidence from a panel survey in Bangladesh

BACKGROUND

Vaccination has proven to be an essential strategy in combating the COVID-19 pandemic. This study aims to discern the factors influencing both the intentions for and actual behavior regarding COVID-19 vaccination among remote, rural populations in Bangladesh.

METHODS

The study utilized panel survey data comprising 1,698 randomly selected household heads. These are predominantly illiterate, of Muslim religion, middle-aged, and male, with agriculture or day labor as primary income source. They reside in 36 locations distributed along the whole 250 km length of the Jamuna River in Bangladesh. Data collection occurred through face-to-face and telephone interviews conducted between September 2021 and October 2022. Descriptive statistics and Ordinary Least Squares regression models were employed to assess influence factors for COVID-19 vaccination intentions and uptake. The analyses considered the constructs of the Health Belief Model alongside sociodemographic characteristics such as gender, age, religion, education, and income source.

RESULTS

Survey respondents showed a notably high willingness to receive the COVID-19 vaccine promptly upon its availability. However, the effectiveness of the Health Belief Model in elucidating COVID-19 vaccination uptake was limited, except for its availability component. Older individuals, those with higher levels of education, and individuals employed in government or formal sector occupations were prompt in receiving the COVID-19 vaccine as it became available. Gender, religion, and the presence of dependents in the household did not exert a significant influence on vaccination uptake.

CONCLUSIONS

The results indicate that a strong willingness to receive the COVID-19 vaccine correlated with an increased likelihood of vaccine uptake once it was available. These findings suggest that a widespread distribution of COVID-19 vaccines to low-income and remote areas could have served as a vital strategy in mitigating the COVID-19 pandemic.

Assessment of Mental Health Status and Its Association With Willingness to Take Vaccine Against COVID-19 Among the Students of Public and Private Universities in Bangladesh

The study investigated mental health status of the students of public and private universities, their willingness to take vaccine against COVID-19, and its association with fear, anxiety, and depression. A cross-sectional electronic survey was conducted from July 26 to September 15, 2021, using a well-structured questionnaire among 504 university students. The average age of the participants was 22.92 ± 2.28 years and 76.98% of them were willing to vaccinate against COVID-19. The fear of COVID-19 was found mild, and depression level was demonstrated moderate among the students irrespective of the university types. Moreover, Masters/MPhil/PhD students and the students living in semi-urban areas had the highest rate of willingness to vaccinate. The study demonstrated that level of fear, anxiety, and depression was directly associated with increased willingness to vaccinate among the tertiary level students in Bangladesh. The outcome of this study sketched a positive association of knowledge and education with better management of pandemic in a society.

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.

Experience and side effects of COVID-19 vaccine uptake among university students: a cross-sectional survey study

Introduction

Many people expressed concern over coronavirus vaccinations' reliability and side effects. This research aimed to assess university students' perceptions and experiences regarding the side effects of the COVID-19 vaccines in Bangladesh.

Method

We conducted an online cross-sectional survey to collect responses from university students vaccinated with any vaccines administered in Bangladesh between November 2021 to April 2022. Bangladeshi university students over the age of 18 and having an internet connection was included in the study. A binary logistic regression analysis along with Pearson's Chi-square test were used to identify COVID-19 vaccine-related side effects predictors after receiving the first dose.

Results

A total of 1,176 participants responded voluntarily to the online study, and most were vaccinated. More than half of the participants received the Sinopharm vaccine (56.5%), while others received Covishield (8.9%), Moderna (7.3%), and Pfizer (5.8%) vaccine. Around 32% of the participants reported side effects after receiving the first dose of the vaccine, including pain and edema (78.4%), body temperature (20.3%), and headache (14.5%), while a few experienced allergy, anxiety, and uneasy feelings. About 17% of the participants reported experiencing side effects after the second dose of the vaccine, including pain and edema (7.5%), body temperature (8.8%), and headache (7.3%). Most side effects were significantly associated with the Moderna vaccine (p < 0.001). Female students and those previously infected with COVID-19 were significantly associated with the side effects after taking the first dose of the vaccine.

Conclusion

We found that side effects are mild and did not pose a significant challenge to Bangladesh's effort in managing and reducing the risk associated with the COVID-19 pandemic.

Moral characteristics predicting COVID-19 vaccination

OBJECTIVE

The current study aims to assess, for the first time, whether vaccination is predicted by different behavioral and cognitive aspects of moral decision-making.

BACKGROUND

Studies linking moral factors to vaccination have largely examined whether vaccination decisions can be explained by individual differences in the endorsement of various principles and norms central to deontology-based arguments in vaccination ethics. However, these studies have overlooked whether individuals prioritize norms over other considerations when making decisions, such as maximizing consequences (utilitarianism).

METHOD

In a sample of 1492 participants, the current study assessed whether vaccination is explained by individual differences in three aspects of moral decision-making (consequence sensitivity, norm sensitivity, and action tendency), while also considering ethics position (idealism, relativism) and moral identity.

RESULTS

Supportive vaccination (vaccine uptake accompanied by a positive attitude toward vaccines) was associated with utilitarianism (increased consequence sensitivity) and increased tolerance to risks and harm toward others. Meanwhile, although those in the non-vaccinated group was associated with higher harm sensitivities, they neither supported nor received the COVID vaccines (when vaccines prevent harm from infection).

CONCLUSION

Pro-vaccination messages may be made more effective by addressing perceptions of harms associated with vaccines and infections, respectively.

Are the 7C psychological antecedents associated with COVID-19 vaccine behaviours beyond intentions? A cross-sectional study on at-least-one-dose and up-to-date vaccination status, and uptake speed among adults in France

BACKGROUND

Widely documented psychological antecedents of vaccination are confidence in vaccines, complacency, convenience, calculation, collective responsibility (5C model) with the recent addition of confidence in the wider system and social conformism. While the capacity of these seven antecedents (7C) to explain variance in COVID-19 vaccine intentions has been previously documented, we study whether these factors also are associated with vaccine behaviours, beyond intentions.

METHODS

From February to June 2022, we recruited a sample of adults in France, including persons with notified recent SARS-CoV-2 infection, along with relatives and randomly selected non-infected persons. Participants completed self-administered questionnaires assessing COVID-19 vaccination history and the 7C antecedents. We defined vaccination behaviours as three outcomes: at-least-one-dose vaccine status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). We conducted multivariable logistic regressions and Cox models.

RESULTS

Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes, although effects were weaker for up-to-date vaccination status and uptake speed. The strongest effects (most vs. least vaccine-favourable attitude level, at-least-one-dose vaccination status) were observed for collective responsibility (OR: 14.44; 95%CI: 10.72-19.45), calculation (OR: 10.29; 95%CI: 7.53-14.05), and confidence in the wider system (OR: 8.94; 95%CI: 6.51-12.27).

CONCLUSION

This study demonstrates that the 7C not only explain vaccine intention, but also vaccine behaviours, and underpins the importance of developing vaccine promotion strategies considering the 7C antecedents.

Covid-19 vaccine uptake and its associated factors among adult population in Dangila district, Awi Zone, Northwest Ethiopia: A mixed method study

INTRODUCTION

Vaccination is the most cost-effective approach that significantly reduces morbidity and mortality related to Coronavirus disease -19 (COVID-19). Nevertheless, there is a lack of information on the COVID-19 vaccine uptake and related factors in Ethiopia including the research area.

OBJECTIVE

To assess COVID-19 vaccine uptake and its associated factors among adult population in Dangila District, Awi Zone, Northwest Ethiopia, 2023.

METHODS

A community-based mixed-type study design was conducted from Oct, 15-Nov 15/2022. The study population was chosen using the multistage stratified random sampling technique for the quantitative study and the purposive sampling method for the qualitative inquiry. The collected data were managed and analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were employed to identify factors associated with vaccine uptakes. In the qualitative part of the study, key informant interview was applied. After the interview was listened, the transcripts were coded and categorized into themes, and analyzed using Atlas.ti 7 software. Finally, the finding was triangulated with the quantitative results.

RESULT

The vaccine uptake among the adult population was found to be 47% (95% CL: 42.7%, 51.0%). History of having test for COVID-19 (AOR: 1.70, 95% CI: 1.02, 2.84), good knowledge about COVID-19 vaccine (AOR; 3.12, 95% CI; 2.11, 4.59), no formal education (AOR: 1.78, 95%: 1.26, 2.58), good attitude (AOR: 3.21, 95% CI: 2.13, 4.89), being in poor Income category (AOR: 1.83, 95% CI: 1.08, 3.06), being female (AOR: 1.75, 95% CI: 1.2, 2.58) and living in rural area (AOR: 3.1, 95% CI: 1.87, 5.12) were significantly associated with vaccine uptake rate. The study also identified that misperceptions about the vaccine efficacy and safety, availability of vaccine, lack of knowledge about the vaccine, mistrust of the corona virus vaccine, fear of adverse effects, social media influence and religious beliefs were found to be barriers of COVID -19 vaccine uptake.

CONCLUSION

In the Dangila district, adult population vaccination uptake for COVID-19 was comparatively low. To raise the rate of vaccination uptake, interventions must focus on the identified modifiable factors.

Disparities in COVID-19 vaccine uptake among rural hard-to-reach population and urban high-risk groups of Bangladesh

BACKGROUND

Vaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background.

METHODS

The purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis.

RESULTS

Our findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively).

CONCLUSION

Vaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide.

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study

BACKGROUND

Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage.

METHODS

A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR.

FINDINGS

A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties.

INTERPRETATION

Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage.

COVID-19 Vaccination Hesitancy among the General Population: A Gender-Based Review and Bibliometric Analysis

December 2019 was momentous since it experienced the trajectory of another novel pathogenic HCoV recognized as 2019-nCoV in Wuhan, China, which further unfurled to all countries on the entire globe at lightning speed. The Majority of COVID-19 vaccines are being manufactured using protein subunits, viral vectors, inactivated viruses, as well as DNA and mRNA vaccine platforms. This study aimed to conduct a gender-based review of COVID-19 vaccine hesitancy among the general population and bibliometric analysis. Various articles related to COVID-19 vaccine hesitancy, either based on their title, abstract, or keywords in the search strategy, were reviewed. For COVID-19 vaccine hesitancy, we used the definition of "Reluctance to receive safe and recommended available vaccines". Accordingly, 408 articles were included in the complete evaluation and the bibliometric analysis. Data Analysis was done using the Vos viewer Software. The strength of co-cited publications showed strong contributors from the American and Asian continents. The words with the maximum weightage based on their occurrences were female, health personnel, acceptance, social media, socio-economic factors, and ethnic groups, as covered in the red cluster. On the other hand, the Overlay Visualization on the right side, based on the total link strength of MeSH items, showed the largest clusters with items such as females, attitude to health, trust, cross-sectional studies, the acceptance of healthcare, rural population, public health, and parents, which were toward the center. The terms toward the periphery, which had less weightage, need more analysis. Greater perceived susceptibility, risk perception, benefits, and low levels of barriers and self-efficacy were the prime reasons for getting vaccinated, more specifically among females. In most instances, the female being the decision-maker of the family needs to be attended to first as she can further change the mindset of the entire family and carry the future forward.

Kubbara E, A. Bakarman M, Al Amri T, Eid R, Alyazidi N, Alkhamesi A, Alasslany A. Misconceptions about COVID-19 vaccine among adults in Saudi Arabia and their associated factors: A cross-sectional study conducted in 2021

Background

It is of utmost importance for the elements that influence public compliance with vaccination against COVID-19 to be assessed, including misconceptions, rumors, and conspiracy theories. Hence, in this study, we aimed to estimate the distribution of the most common misconceptions regarding COVID-19 vaccines and their predictors in Saudi Arabia.

Methods

We distributed an online questionnaire to participants aged 18 years or older. The survey included two sections. The first section comprised questions related to participants' demographic characteristics, level of education, and their sources of information about COVID-19. The second section assessed participants' perceptions regarding 11 of the most common misconceptions regarding COVID-19 vaccines, rated using a 5-point Likert scale. Using ordinal logistic regression, we conducted an evaluation of the relationships among different predictors including age, sex, educational level, and sources of information, as well as acceptance of misconceptions about vaccination.

Results

The most widely accepted misconception was that the COVID-19 vaccine had severe side effects, with 34.8% of participants believing this misinformation. Factors that were significantly associated with acceptance or non- acceptance of misconceptions were: 1) sex, with female respondents in this survey accepting rumors significantly more often than male respondents (p<0.001); 2) educational level, especially secondary school, was associated with a significantly lower acceptance of misconceptions (p=0.001). In total, 60.5% of participants used social media as their primary source of information, which was also a significant positive predictor of acceptance of misconceptions (p=0.034).

Conclusion

It is of critical importance to increase assurance regarding the safety of COVID-19 vaccines, the issue most likely to involve misconceptions, and to address the elements that affect belief in rumors among the population.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh

INTRODUCTION

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

METHODS

A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance.

RESULTS

Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy.

CONCLUSIONS

These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

The disparity in hesitancy toward COVID-19 vaccination between older individuals in nursing homes and those in the community in Taizhou, China

PURPOSE

Older individuals are priority coronavirus disease 2019 (COVID-19) vaccine recipients. Our aim was to investigate the prevalence of and factors influencing vaccine hesitancy in older individuals living in nursing homes and communities.

METHODS

A self-administered COVID-19 vaccine hesitancy survey was conducted from September 2021 to December 2021 among people aged ≥ 60 years in eight nursing homes (382 participants) and the community (112 participants) in Taizhou, China. The response rate was 72.1% (382/530) for older adults in nursing homes and 68.7% (112/163) for older adults in the community.

RESULTS

We found that 58.1% of the older individuals in nursing homes and 36.6% of those in the community were hesitant to receive the COVID-19 vaccine and that there was a statistically significant difference (P < 0.001). Multiple logistic regression results indicated that the main factors influencing hesitation among the older individuals in nursing homes were being male (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI): 1.01-2.76); their cognitive level, including having a high perceived risk of COVID-19 infection (OR = 3.06, 95% CI: 1.73-5.43) or the perception of low vaccine safety (OR = 3.08, 95% CI: 1.545- 6.145); anxiety (OR = 3.43, 95% CI: 1.96-5.99); and no previous influenza vaccination (OR = 1.82, 95% CI: 1.13-2.93); whereas those for older individuals in the community were comorbid chronic diseases (OR = 3.13, 95% CI: 1.11- 8.78) and community workers not recommending the vaccine (OR = 8.223, 95% CI: 1.77-38.27).

CONCLUSION

The proportion of older individuals in nursing homes who were hesitant to receive the COVID-19 vaccine was significantly higher than for older individuals in the community. Targeted measures should be implemented to reduce vaccine hesitancy and improve vaccination rates in response to the special environment of nursing homes and the characteristics of this population.

Knowledge and acceptance of malaria vaccine among parents of under-five children of malaria endemic areas in Bangladesh: A cross-sectional study

BACKGROUND

Malaria exists as an endemic in many countries including Bangladesh and the malaria vaccine is not yet available here. The study aimed to assess the level of knowledge and acceptance of the malaria vaccination among the parents of children under the age of five in Bangladesh's malaria-endemic areas and the sociodemographic, behavioural, and household factors associated with the acceptance and knowledge of the malaria vaccine.

METHODS

From January to March 2022, a cross-sectional study was conducted in all five malaria-endemic districts of Bangladesh, involving 405 parents of children under the age of 5 who met the inclusion criteria. Multiple logistic regression was used to analyze the factor affecting parents' acceptance and knowledge of malaria vaccination in children under five and other variables.

RESULTS

Majority (54%) of the respondents were mothers. Almost half (49%) of the respondents were aged between 26 and 35 years old and around 90% were from rural areas. A small portion (20%) of the participants were housewives and 46% of them completed primary education. Overall, 70% of the study participants reported that they would accept malaria vaccination independently. About one-fourth (25%) heard about the malaria vaccine and 48% of them mentioned health professionals as the source of information. Knowledge of malaria vaccination was found associated with residence, income, and family size. Acceptance and knowledge were both associated with residence, education, occupation, income, and family size. In a multivariable analysis, housing structure, house wall, house window, knowledge of malaria, testing for malaria, and being diagnosed with malaria were all associated with knowledge of and acceptance of getting vaccinated against malaria.

CONCLUSIONS

The present study highlights the necessity of creating awareness of malaria vaccines in epidemic areas of Bangladesh. This study offers crucial data to develop a policy for a novel malaria vaccine, supporting its adoption in Bangladesh.

PUBLIC CONTRIBUTION

This study was based on interviews. The interviewees were recruited as public representatives from the malaria-endemic area to assist us in building an understanding of knowledge and acceptance of the malaria vaccine among parents of under-five children in Bangladesh.

Potential determinants of childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh: A cross-sectional study to assess the effects of education

BACKGROUND

Rapid corona virus disease 2019 (COVID-19) vaccination drives aimed to immunize primary school-aged youth have a potential for health safety and supportive academic attainment. This study aimed to identify the potential factors influencing childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh and assess the effects of health education on vaccine confidence and receptivity.

MATERIALS AND METHODS

This cross-sectional study used a bilingual, multi-item, closed-ended, anonymous questionnaire adopted from the extant literature studies on the topic. Data were collected purposively by the face-to-face interview approach. In total, 627 primary school's stakeholders participated in this study. The binary logistic regressions and Chi-square tests were employed to investigate and rationalize the study-outlined objectives where <0.05 was considered statistically significant.

RESULTS

The pooled childhood vaccine confidence and receptivity against COVID-19 was 91% (95% CI 89-93) among the primary school's stakeholders. The regression analysis revealed that of eight potential determinants of vaccine confidence, "safety" and "effectiveness" had a highly significant (P = 0.006, P = 0.001, respectively) and positive association and "efficacy" had a significant (P = 0.03) and positive association, while "rumor" had a highly significant (P = 0.000) and negative association with childhood vaccine confidence. The analysis also showed that"health education" had a significant (P = 0.04) and positive association with childhood vaccine confidence and receptivity against COVID-19. Although the odds ratio for receiving childhood vaccine was found to be 0.6, the result was insignificant (P > 0.05) in the Chi-squared test. Hence, there was no vaccine-hesitant risky recipient group identified in implementing upcoming childhood COVID-19 vaccination programs.

CONCLUSIONS

This study confirms the importance of a positive perception of vaccine safety, efficacy, effectiveness, and health education for vaccine confidence under any circumstances. Childhood COVID-19 vaccine confidence is Improved if vaccination data become more available to the guardians and school community. Public health education would be considered a preferred approach for building trust and fostering childhood vaccine confidence against COVID-19 in Bangladesh.

Acceptance of Annual Booster Doses of COVID-19 Vaccines Among Indian Healthcare Professionals: A Pan-India Cross-Sectional Survey

Introduction The emergence of coronavirus disease 2019 (COVID-19) posed significant challenges to global health, leading to the declaration of a pandemic by the World Health Organization. Vaccination efforts have effectively reduced severe outcomes and mortality, but breakthrough infections and new variants are of concern. In response, annual booster doses of COVID-19 vaccines are being considered to maintain immunity. Healthcare professionals, as frontline workers, play a pivotal role in vaccination campaigns. This study explores their attitudes toward and willingness to accept annual COVID-19 booster doses in India. Methods A pan-India cross-sectional survey was conducted among healthcare professionals, including faculty, resident doctors, interns, and nursing staff, across Indian medical and nursing colleges. Convenience sampling was used to collect responses via an online questionnaire. The questionnaire assessed demographics, vaccine status, attitudes toward COVID-19 vaccination, and willingness to accept annual booster doses. Multivariate analysis was performed to identify predictors of booster dose acceptance. Results A total of 535 participants responded from 28 states and 8 union territories of India. Most were 34.2 years (± 11.1 SD), and 372 (69.5%) had taken Covishield (Serum Institute of India, Pune, India) as their primary vaccine. While 525 (98.1%) had taken the first dose and 518 (96.8%) of them had taken the second dose, only 333 (62.2%) had received a booster. Around 318 (60%) of healthcare professionals were willing to accept an annual booster dose. The mean attitude score toward annual booster doses was 75.4 (range: 28-111). Healthcare professionals' trust in government recommendations and medical experts significantly influenced their willingness to accept annual booster doses. Conclusion This study provides insights into the attitudes of healthcare professionals in India toward annual COVID-19 booster doses. At the same time, a significant proportion showed a willingness to accept boosters.

Unpacking COVID-19 Vaccine Attitudes: Exploring Hesitancy and Acceptance Among Undergraduate Students in Bangladesh

BACKGROUND

Vaccine hesitancy is a significant global health concern, and mass vaccination is essential in preventing the spread of COVID-19. Undergraduate students need to be prioritized for vaccination as they continue their academic curriculum physically. However, limited research explores vaccine hesitancy and acceptance among undergraduate students in Bangladesh. Therefore, this study evaluated vaccine hesitancy and acceptance among this population.

METHOD

A web-based cross-sectional study was conducted between May and June 2021 using a structured questionnaire to assess COVID-19 vaccine hesitancy and acceptance among undergraduate students in Bangladesh. The Oxford Covid-19 Vaccine Hesitancy Scale was used to measure vaccine hesitancy. The study used convenient sampling.

RESULT

Across the country, 334 undergraduate students participated in this study on COVID-19 vaccine acceptance, with a mean age of 22.4 years. Most participants were male and unmarried, most having spent four years at university. 89.52% of participants would accept a COVID-19 vaccine if it were suggested by educational institutions or available, while 4.49% refused to receive the COVID-19 vaccine. Participants showed low levels of vaccine hesitancy, with a mean score of 10.77 on the Oxford COVID-19 Vaccine Hesitancy Scale. Most participants had a positive attitude towards receiving the vaccine, with the majority wanting to get it as soon as it becomes available. No association was found between vaccine acceptance and participants' background characteristics.

CONCLUSION

Our study found a high level of vaccine acceptance among undergraduate students in Bangladesh, indicating that this group can be vaccinated quickly, significantly accelerating vaccination goals. However, further large-scale studies are recommended among vulnerable groups, including school and college students, to ensure vaccine preparedness.

Acceptance of COVID-19 vaccine booster dose among the people of Bangladesh: A cross-sectional study

Vaccine booster dose (VBD) provides a potential therapeutic alliance in preventing breakthrough infection and new variant's arrival while preserving long-lasting host immunity. This study aimed to analyze COVID-19 VBD willingness and identified the key determinants of VBD acceptance among the general people of Bangladesh. This survey-based study applied a quantitative research paradigm. A validated, anonymous, and multi-item questionnaire was adopted through a theoretical review of pertinent literature on the topic. Data were collected between August 2022─October 2022, and sampling was done randomly. A total of 704 individuals were invited via face-to-face interview approach; however, 13.8 % of them declined to give consent, which resulted in the participation of 607 potential respondents. The main outcome measure was COVID-19 VBD acceptance willingness. Binary logistic regression analysis was conducted to rationalize the study's objectives. The pooled COVID-19 booster vaccine acceptance rate was 70.0 % (95 % confidence Interval [CI]: 67─73) among Bangladeshi people. An analysis of binary logistic regression revealed that, out of 14 potential factors, "efficacy", "repeated immunity", "communication", and "trust" showed highly significant positive association (adjusted odds ratio [aOR ] = 2.151 95 % CI: 1.391─ 3.508, aOR = 2.033 95 % CI: 1.299─ 3.181, and aOR = 2.552 95 % CI: 1.557─4.183 respectively, p<0.01), and "equal safety", "risk-benefit ratio" and "community protection" had significant positive association (aOR = 1.739 95 % CI: 1.070─2.825, aOR = 1.712 95 % CI: 1.116─2.627, and aOR = 1.628 95 % CI: 1.395─0.998, p<0.05) with VBD acceptance. However, post-vaccination "side effects" showed significant negative (aOR = 0.393 95 % CI: 0.237─0.674, p<0.01) associations with VBD acceptance. The odds of accepting the COVID-19 vaccine booster was found 1.26, and it was found insignificant (p>0.05) in the Chi-squared test. Bangladeshi people expressed a moderately high level response to COVID-19 VBD acceptance. A positive attitude towards the COVID-19 VBD is an outcome of this study, regardless of the circumstances, as far as safety, efficacy, perceived health benefits, communication, trust, and community resistance are concerned. Post-vaccination side effects fear was the primary reason for booster dose skepticism as well as a barrier to administering booster shots. The confidence in COVID-19 VBD will be boosted when mass people are effectively communicated and vaccine's data become more available publicly.

Public opinion on COVID-19 vaccine prioritization in Bangladesh: Who gets the vaccine and whom do you leave out?

One of the most challenging aspects of the COVID-19 pandemic is the inability to ensure equitable distribution of vaccines to fight the pandemic. Many governments around the globe had to prioritize and perform a triage in distributing the vaccines due to the limited supply as well as a lack of financial strength to acquire a sufficient number of vaccines in time. The present study assessed the public opinion in Bangladesh regarding vaccination prioritization strategy and its associated aspects. Due to the infectious nature of the viral transmission, the study used an online survey and collected a sample of 2291 respondents, distributed proportionally across sex, and income groups. Descriptive statistics and multinomial logistic regression modelling were utilized to conduct the analyses. The results emphasized unanimous preference of prioritized vaccination leaning towards the frontline workers, the severely sick and the elderly. However, the segregation across ethnicity was noted with no major preference among sexes or religion. The results reinforce the Bangladesh government's undertaken strategy of prioritization. However, the preference rankings varied across sociodemographic factors including self-assessed COVID-19 knowledge and income tiers, among others. The findings underline the necessity of improved risk communication strategies to ensure public confidence and conformity to vaccination efforts and their effective deployment across the country.

Childhood Vaccine Attitude and Refusal among Turkish Parents

We aimed to understand and resolve anti-vaccine attitudes by examining the factors associated with vaccine attitudes and exploring potential strategies to improve childhood vaccination rates. Between 2014 and 2021, a total of 628 families refused vaccination in Adiyaman. A total of 300 families accepted visits and were visited. During the visits, the families were administered a questionnaire to determine the reasons for vaccine rejection and their opinions on the matter. While providing general information about the vaccine, parents were encouraged to reconsider their decision, and at the end, parents completed the questionnaire. The questionnaire included sociodemographic questions, reasons for vaccine refusal, and a vaccine attitude scale. Among the participants in the study, 9.3% were convinced about the vaccine. The mean vaccine attitude scale score was calculated as 23.6 ± 2.5 (min = 15-max = 29). Significantly higher rates of persuasion were observed among fathers (17.3%) compared to mothers (7.7%) (p = 0.038). Participants who had received some vaccinations had a higher rate of persuasion (11.6%) compared to those who had not received any vaccinations (2.6%) (p = 0.02). Childhood vaccine refusal is a complex issue that has been the subject of numerous studies. Studies on this subject will increase awareness of vaccines.

Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study

Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.

Global acceptance of COVID-19 vaccine among persons with diabetes: A systematic review and meta-analysis

AIM

This review aimed to estimate the level of acceptance of COVID-19 vaccine among persons with diabetes.

METHODS

A systematic search was conducted on PubMed, MEDLINE, Embase, and CINAHL to identify relevant studies for this review. A random-effects meta-analysis was performed to generate an overall estimate of vaccine acceptance. The I² statistic was used to quantify the degree of variation across studies, and subgroup analysis was conducted to identify the sources of heterogeneity. The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).

RESULTS

This review included 18 studies involving 11,292 diabetes patients. The pooled prevalence of COVID-19 vaccine acceptance among persons with diabetes was 76.1% (95% CI: 66.7% - 83.5%). The pooled prevalence across the continent ranged from 68.9% (95% CI: 47.8% - 84.3%) in Asia to 82.1% (95% CI: 80.2% - 83.8%) in Europe. Barriers to vaccine acceptance included misinformation, lack of information, mistrust, health concerns, and external influences.

CONCLUSION

The barriers to vaccine acceptance identified in this review, could inform the formulation of health policies and public health interventions that are specifically tailored to address the needs of persons with diabetes.

Cost-Effectiveness Analysis of COVID-19 Inactivated Vaccines in Reducing the Economic Burden of Ischaemic Stroke after SARS-CoV-2 Infection

Due to significant economic burden and disability from ischaemic stroke and the relationship between ischaemic stroke and SARS-CoV-2 infection, we aimed to explore the cost-effectiveness of the two-dose inactivated COVID-19 vaccination program in reducing the economic burden of ischaemic stroke after SARS-CoV-2 infection. We constructed a decision-analytic Markov model to compare the two-dose inactivated COVID-19 vaccination strategy to the no vaccination strategy using cohort simulation. We calculated incremental cost-effectiveness ratios (ICERs) to evaluate the cost-effectiveness and used number of the ischaemic stroke cases after SARS-CoV-2 infection and quality-adjusted life-years (QALYs) to assess effects. Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. We found that the two-dose inactivated vaccination strategy reduced ischaemic stroke cases after SARS-CoV-2 infection by 80.89% (127/157) with a USD 1.09 million as vaccination program cost, saved USD 3675.69 million as direct health care costs and gained 26.56 million QALYs compared with no vaccination strategy among 100,000 COVID-19 patients (ICER < 0 per QALY gained). ICERs remained robust in sensitivity analysis. The proportion of older patients and the proportion of two-dose inactivated vaccination among older people were the critical factors that affected ICER. This study suggests the importance of COVID-19 vaccination is not only in preventing the spread of infectious diseases, but also in considering its long-term value in reducing the economic burden of non-communicable diseases such as ischaemic stroke after SARS-CoV-2 infection.

COVID-19 vaccine hesitancy: A Systematic review of cognitive determinants

Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020-2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people's trust in vaccines during the pandemic and mass vaccinations.

COVID-19 Vaccine Acceptance, Attitude and Perception among Slum and Underserved Communities: A Systematic Review and Meta-Analysis

This systematic review summarises the literature on Coronavirus Disease 2019 (COVID-19) vaccination, including acceptance, uptake, hesitancy, attitude and perceptions among slum and underserved communities. Relevant studies were searched from PubMed, Scopus, Web of Science and Google Scholar, following a pre-registered protocol in PROSPERO (CRD42022355101) and PRISMA guidelines. We extracted data, used random-effects models to combine the vaccine acceptance, hesitancy and uptake rates categorically, and performed meta-regression by R software (version 4.2.1). Twenty-four studies with 30,323 participants met the inclusion criteria. The overall prevalence was 58% (95% CI: 49-67%) for vaccine acceptance, 23% (95% CI: 13-39%) for uptake and 29% (95% CI: 18-43%) for hesitancy. Acceptance and uptake were positively associated with various sociodemographic factors, including older age, higher education level, male gender, ethnicity/race (e.g., Whites vs African Americans), more knowledge and a higher level of awareness of vaccines, but some studies reported inconsistent results. Safety and efficacy concerns, low-risk perception, long distance to vaccination centres and unfavourable vaccination schedules were prominent reasons for hesitancy. Moreover, varying levels of attitudes and perceptions regarding COVID-19 vaccination were reported with existing misconceptions and negative beliefs, and these were strong predictors of vaccination. Infodemic management and continuous vaccine education are needed to address existing misconceptions and negative beliefs, and this should target young, less-educated women and ethnic minorities. Considering mobile vaccination units to vaccinate people at home or workplaces would be a useful strategy in addressing access barriers and increasing vaccine uptake.

Factors of Compliance of Dental Patients in Primary Health Care Services during the Pandemic

The compliance of dentists with good hygiene practices during the COVID-19 pandemic was essential to minimize the transmission of SARS-CoV-2 strains, and the pandemic has significantly interrupted the provision of oral health care to many individuals. We aimed to examine, in a cross-sectional study, factors affecting dental patients' compliance in primary dental health settings during the pandemic period. The present study was conducted on 300 dental patients visiting four private dental offices in the city of Larissa in Central Greece during the period October-December 2021. The patients in the study sample were of an average age of 45.79 years with a standard deviation of 15.54 years, and 58% of the sample were females. A significant proportion of the participants, 22%, reported that they would be influenced if they knew that the dentist had been ill with COVID-19 despite being fully recovered. A total of 88% of the participants reported that they would feel safe if they knew their dentist was vaccinated against COVID-19. Regarding the information received by dentists, 88% of the participants agreed that the dentist's role is important in dealing with the COVID-19 pandemic, and 89% of them agreed that the information they received from the dentist about the COVID-19 pandemic was sufficient. One-third of the total sample reported that COVID-19 negatively impacted keeping dental appointments, and 43% of the sample kept scheduled appointments. A total of 98% reported that the dentist followed all health protocols against COVID-19 and that their office was equipped to follow health protocols. In the present study, we observe that dentists had adequate knowledge of, attitudes towards, and practices of infection control protocols against COVID-19 during the second wave, according to patients' perceptions.

Multi-dimensional potential factors influencing COVID-19 vaccine booster acceptance and hesitancy among university academic community in Bangladesh: A cross-sectional comparative study

BACKGROUND AND AIMS

Vaccination is the most powerful public health intervention proven to be safe and effective in the battle against the coronavirus disease-2019 (COVID-19) pandemic. Despite the potential therapeutic benefits of primer vaccine dosage regimens, public perceptions of COVID-19 vaccine booster dose (VBD) acceptance and hesitancy vary among various sub-group populations. This study investigates COVID-19 vaccine booster dose acceptance and compares the multi-dimensional potential factors influencing VBD acceptance and hesitancy among university teachers and the student community in Bangladesh.

METHODS

This web-based cross-sectional study employed an anonymous, validated, and self-administered questionnaire. The questionnaire items were adopted from a theoretical analysis of the recent relevant literature. The questionnaire was deployed in an on-line-enabled format (Google form) and conveniently distributed to 685 teachers and 990 students between 15th June, 2022 and 15th August, 2022 which resulted in the participation of 1250 (505 teachers vs.745 students) total respondents (response rate 73.72% vs. 75.25%) from various universities in Bangladesh. A non-parametric analytical tool (binary logistic regression) was applied to rationalize the study objectives and a Chi-squared test was performed to estimate the booster- hesitant risky group.

RESULTS

The pooled COVID-19 vaccine booster dose acceptance rates were 84.6% (95% CI 81.5─87.7) and 67.2% (95% CI 63.8─70.6) for teachers and students in the university academic community, respectively. In employing a binary logistic regression, this study revealed that out of twelve (12)multi-dimensional key predictors, "equal safety", "risk-benefit ratio", and "variant control" had a significant positive association with VBD acceptance in both sets (p = 0.000, p = 0.000, and p = 0.005, respectively). Varied effects were found for several predictors; post-vaccination "side effects" had a significant negative association (p = 0.020) and "community protection" had significant positive association (p = 0.034) with vaccine booster dose acceptance in the teachers community while these variables were insignificant in the students cohort. "Trust" had a highly significant positive association (p = 0.000);"communication" and "academic attainment" had significant positive associations (p = 0.033 and 0.024, respectively) with VBD acceptance in the students cohort, while these predictors were insignificant in the teachers community. Women were more likely to receive a third dose of the vaccine (OR = 1.4 vs. 0.9 between teacher and student model); however, no significant association between gender and booster vaccine acceptance was found in a comparative Chi-squared model. Therefore, statistically, the booster vaccine-hesitant risky group was not found to implicate the massive booster vaccine drive among the university academic community.

CONCLUSIONS

COVID-19 booster vaccine acceptability among the student cohort was slightly lower than pre-roll-out intent. The teacher community was more inclined to get booster vaccinated. Moreover, differences were found between the multi-dimensional potential factors associated with VBD acceptance among teachers and students in university settings. This study explicitly confirmed positive attitudes toward the safety, health benefits, and variants control of the COVID-19 VBD under any circumstances. Post-vaccination side effect concern was found to be a barrier to administering booster shots and a reason for booster skepticism. Tailored communication and health education interventions need to be adopted to improve the public awareness of booster vaccine consequences, and limit booster skepticism.

Assessing the Self-reported After Events Following Immunization of COVID-19 Vaccines in Turkey and Bangladesh

Though mass vaccination programs helped to reduce the severity of the ongoing pandemic, various unwanted effects were reported in Turkey and Bangladesh after taking vaccines. The purpose of this study was to evaluate and compare the adverse effects of several vaccines in Turkey and Bangladesh and how the population of both countries prioritizes the continuation of vaccination compared to the side effects. An online survey with a pretest was conducted to gather data over the research period from July 10, 2021 to December 10, 2021. Finally, the questionnaire was shared with the mass population of Turkey and Bangladesh who have received at least one or two doses of the COVID-19 vaccines. The quality of the questionnaire was evaluated with Cronbach's alpha test. The study consisted of 1508 respondents from Bangladesh and 602 respondents from Turkey. Among the total 2110 respondents, 50.0% were male 66.8% were from the 18-30 years age range, and 77.5% reported living in the city area. Among all the respondents, 64.99% of those vaccinated in Bangladesh and 67.28% of those vaccinated in Turkey reported side effects after vaccinations. Participants receiving mRNA vaccines (Pfizer and Moderna) experienced the most side effects, with many reporting pain at the injection site in both nations. Following that, fever, body pain, and headache were common in Bangladesh, whereas body pain, fatigue, and arm numbness were common in Turkey. The study found no significant adverse events reported in Turkey and Bangladesh following the first and second doses of COVID-19 vaccination. These COVID-19 vaccines showed similar patterns of efficacy and safety during the short period of analysis. Vaccines from different manufacturers showed a non-significant level of adverse events during this binational AEFI approach to COVID-19 vaccines. More studies are recommended on the efficacy and safety of several vaccines to discover unexpected effects.

Uptake of COVID-19 vaccines and associated factors among adults in Uganda: a cross-sectional survey

OBJECTIVE

COVID-19 pandemic remains one of the most significant public health challenges ever faced globally. Vaccines are key to ending the pandemic as well as minimise its consequences. This study determined the uptake of COVID-19 vaccines and associated factors among adults in Uganda.

DESIGN, SETTING AND PARTICIPANTS

We conducted a cross-sectional mobile phone survey among adults in Uganda.

MAIN OUTCOME VARIABLE

Participants reported their uptake of COVID-19 vaccines.

RESULTS

Of the participants contacted, 94% (1173) completed the survey. Overall, 49.7% had received COVID-19 vaccines with 19.2% having obtained a full dose and 30.5% an incomplete dose. Among the unvaccinated, 91.0% indicated intention to vaccinate. Major reasons for vaccine uptake were protection of self from COVID-19 (86.8%) and a high perceived risk of getting the virus (19.6%). On the other hand, non-uptake was related to vaccine unavailability (42.4%), lack of time (24.1%) and perceived safety (12.5%) and effectiveness concerns (6.9%). The factors associated with receiving COVID-19 vaccines were older age (≥65 years) (Adjusted Prevalence Ratio (APR)=1.32 (95% CI: 1.08 to 1.61)), secondary (APR=1.36 (95% CI: 1.12 to 1.65)) or tertiary education (APR=1.62 (95% CI: 1.31 to 2.00)) and health workers as a source of information on COVID-19 (APR=1.26 (95% CI: 1.10 to 1.45)). Also, reporting a medium-income (APR=1.24 (95% CI: 1.02 to 1.52)) and residence in Northern (APR=1.55, 95% CI: 1.18 to 2.02) and Central regions (APR=1.48, 95% CI: 1.16 to 1.89) were associated with vaccine uptake.

CONCLUSIONS

Uptake of COVID-19 vaccines was moderate in this sample and was associated with older age, secondary and tertiary education, medium-income, region of residence and health workers as a source of COVID-19 information. Efforts are needed to increase access to vaccines and should use health workers as champions to enhance uptake.

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

Travel behaviour changes and risk perception during COVID-19: A case study of Malaysia

The COVID-19 pandemic has disrupted travel behaviours due to the need for movement restrictions. The restrictions adversely affected various aspects of health and the economy. This study aimed to investigate factors affecting trip frequency during the recovery period of the COVID-19 pandemic in Malaysia. An online national cross-sectional survey was conducted to collect data in conjunction with different movement restriction policies. The questionnaire includes socio-demographics, experience with COVID-19, risk perception of COVID-19, and trip frequency on several activities during the pandemic. Mann Whitney U was conducted to determine whether there were statistically significant differences between the socio-demographic factors for the respondents in the first and second surveys. Results show no significant difference in socio-demographic factors except for the level of education. The results indicate that the respondents from both surveys were comparable. Next, Spearman correlation analyses were conducted to find significant correlations between trip frequencies toward socio-demographics, experience with COVID-19 and risk perception. There was a correlation between the frequency of travel and risk perception for both surveys. Regression analyses were performed based on the findings to investigate trip frequency determinants during the pandemic. Perceived risk, gender, and occupation influenced the trip frequencies for both surveys. By understanding the influence of risk perception on the frequency of travel, the government can identify the appropriate policy during a pandemic or health emergency to avoid impeding normal travel behaviour. Thus, people's mental and psychological well-being are not negatively affected.

Attitudes towards receiving COVID-19 vaccine and its associated factors among Southwest Ethiopian adults, 2021

INTRODUCTION

Many countries around the world are still affected by the global pandemic of coronavirus disease. The vaccine is the most effective method of controlling Coronavirus Disease 2019 (COVID-19). However, attitudes toward vaccination are heavily affected by different factors besides vaccine availability.

OBJECTIVES

This study aimed to determine community attitudes toward the COVID-19 vaccine in Gurage Zone, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from November 15th to December 15th, 2021. A simple random sampling technique was used to select 364 participants in the study area. An interview-administered structured questionnaire was used to collect the data; the data was entered into Epidata 3.1 version, and then exported to SPSS version 23 for further analysis. Descriptive statistics were used to determine the characteristics of study participants. Binary and multivariable logistic regression analyses with a p-value of less than 0.05 were used as a measure of significance.

RESULTS

In this study, 44.7% of study participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm [AOR: 1.85; 95% CI (1.15-2.96)], Having ever had a chronic disease [AOR: 3.22; 95% CI (2.02-5.14)], community belief on the effectiveness of the vaccine [AOR: 2.02; 95% CI (1.27-3.22)], and average monthly income 3001-5000 ETB [AOR: 0.54; 95% CI (0.30-0.97)], average monthly income 5001-10000 ETB [AOR: 0.48; 95% CI(0.27-0.86)] were statistically significantly towards COVID-19 vaccination.

CONCLUSIONS

Overall, less than half of the participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm, having ever had a chronic disease, community belief in the effectiveness of the vaccine, and average monthly income were determinant factors of the community's attitude toward COVID-19 vaccination. As a result, information conversation with the community's awareness of the COVID-19 vaccination in reducing vaccine-related suspicion.

Prevalence of COVID-19 Vaccine Hesitancy and Its Associated Factors among Chronic Disease Patients in a Resource Limited Setting in Ethiopia: A Cross-Sectional Study

Background. The COVID-19 pandemic disproportionately affects patients with chronic diseases. Thus, chronic disease patients are among the first high-risk population groups to get vaccinated. This might be challenged by vaccine hesitancy as it is one of the top ten global health issues for 2019. Furthermore, vaccination myths and conspiracy theories have been proliferating, and the developing world can readily embrace them, which might cause vaccine hesitancy. However, there is a paucity of evidence regarding chronic illness patient’s willingness to be vaccinated. As a result, the aim of this study is to determine the magnitude of vaccine hesitancy and associated factors among chronic disease patients in Ethiopia. Method. An institutional-based cross-sectional study was conducted among adult ambulatory chronic disease patients who were selected using stratified sampling technique from June 1 to August 1, 2021. Data were collected through a face-to-face interviewer-administered questionnaire. Vaccine hesitancy was measured based on a questionnaire which was adapted from the reviewed literature. Bivariable and multivariable logistic regression was used to identify factors, and variables with $p<0.05$ were considered statistically significant. Result. A total of 422 respondents participated in the survey; the response rate was 99.7%. The mean age of the participants was 45 years  $\pm$  16.95 and 228 (54%) of them were male. Almost half of the respondents (49.5%) were hesitant toward the COVID-19 vaccine. Participants who were male (AOR = 1.56, 95% CI: 1.03, 2.35), having good knowledge about the COVID-19 vaccine (AOR = 1.60 95% CI: 1.06, 2.41) and having a comorbidity (AOR = 3.36, 95% CI: 1.73, 6.56), were factors associated with the acceptance of the COVID-19 vaccine. Conclusion. The level of COVID-19 vaccine hesitancy was high. The COVID-19 vaccine’s acceptability was influenced by being a man, having knowledge about the vaccine and having comorbidities. Furthermore, the most prevalent reason for refusing to take the vaccination is a fear that it may not be safe. As a result, public awareness campaigns should concentrate on delivering more information about the COVID-19 vaccine’s safety and efficacy. Furthermore, it is critical to disseminate accurate information, particularly among women, and to educate people about the vaccine.

What attributes influence rural household's willingness to get vaccinated for COVID-19? Perspectives from six Chinese townships

Since the onset of the COVID-19 pandemic, vaccinations have been identified as the most effective mitigation strategy against the deadly virus. This has led developed nations to accelerate research and shorten the licensure process for COVID-19 vaccines, but these changes have caused widespread concerns about vaccine safety. Research literature has long indicated that citizens' perceptions of protective actions will determine their behaviors, and thus, the relationship between vaccine perception and vaccination intention needs to be assessed. To better understand vaccination willingness, especially in rural populations, this study surveyed 492 households from six townships in the Ya'an region of China's Sichuan Province in November 2020. The survey followed the Protective Action Decision Model (PADM) framework for collecting perceptions about the influenza and COVID-19 vaccines as protective actions, information sources, emergency preparedness, emotional response, and demographic characteristics. The results showed that influenza vaccine perceptions significantly affected people's COVID-19 vaccination perceptions and intentions. Unlike previous vaccination willingness and other COVID-19 studies, this study found that perceptions of resource-related attributes and health-related attributes both affected COVID-19 vaccination intentions, but the former were slightly stronger than the latter. Moreover, these effects were strongest among respondents who had the most positive perceptions of their influenza vaccine experience. This study's findings will benefit local authorities in designing appropriate policies and measures (e.g., hazard education, risk communication, vaccination convenience enhancement) for increasing vaccination compliance for the current and future pandemics.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

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.