Willingness to participate in COVID-19 vaccine trials; a survey among a population of healthcare workers in Uganda

The relationship between trust in federal oversight of vaccine safety and willingness to participate in COVID-19 clinical trials: a repeated measures study of Philadelphia residents (September 2021 - March 2023)

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic precipitated an urgent need for clinical trials to discover safe and efficacious treatments. We examined how COVID-19 experiences, clinical trial awareness, and trust in the vaccine safety process were associated with willingness to participate in COVID-19 clinical trials. The objective was to investigate the relationship between trust in federal oversight of vaccine safety and willingness to participate in clinical trials for COVID-19 treatment across four distinct time points over an 18-month period during the COVID-19 pandemic.

METHODS

We used four waves of data collected from September 2021 to March 2023 among 582 Philadelphia residents (with a missing data rate of 0.9%). Generalized estimating equations estimated the association between willingness to participate in COVID-19 clinical trials and participants' trust in the federal government's oversight of COVID-19 vaccine safety, COVID-19-related variables (COVID-19 related health challenges, history of COVID-19 infection), awareness of clinical trials and how to enroll in them, and sociodemographic characteristics (age, race/ethnicity, sexual orientation, gender, parental status, education, and insurance).

RESULTS

On average, willingness to participate in a COVID-19 clinical trial was positively associated with greater trust in the federal government's oversight of vaccine safety [β = 0.34, 95% confidence interval (CI): 0.15-0.53], having COVID-19 (β = 0.40, 95% CI: 0.08-0.73), awareness of clinical trials (β = 0.38, 95% CI: 0.04-0.73), and knowledge of how to enroll (β = 0.83, 95% CI: 0.44-1.23). Among sociodemographic characteristics, race/ethnicity (p = 0.001) and gender (p = 0.018) were identified as predictors for COVID-19 trial willingness.

CONCLUSION

Willingness to participate in clinical trials may be bolstered by strengthening the public's trust in the federal government's role within vaccine safety oversight, increasing the perceived relevance of clinical trials to individuals' health and well-being, and offering tailored information to educate diverse communities about ongoing trials and how to enroll in them.

Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study

BACKGROUND

The VACCELERATE Pan-European Scientific network aims to strengthen the foundation of vaccine trial research across Europe by following the principles of equity, inclusion, and diversity. The VACCELERATE Volunteer Registry network provides access to vaccine trial sites across the European region and supports a sustainable volunteer platform for identifying potential participants for forthcoming vaccine clinical research.

OBJECTIVE

The aim of this study was to approach members of patient advocacy groups (PAGs) across Europe to assess their willingness to register for the VACCELERATE Volunteer Registry and their perspectives related to participating in vaccine trials.

METHODS

In an effort to understand how to increase recruitment for the VACCELERATE Volunteer Registry, a standardized survey was developed in English and translated into 8 different languages (Dutch, English, French, German, Greek, Italian, Spanish, and Swedish) by the respective National Coordinator team. The online, anonymous survey was circulated, from March 2022 to May 2022, to PAGs across 10 European countries (Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Spain, and Sweden) to share with their members. The questionnaire constituted of multiple choice and open-ended questions evaluating information regarding participants' perceptions on participating in vaccine trials and their willingness to become involved in the VACCELERATE Volunteer Registry.

RESULTS

In total, 520 responses were collected and analyzed. The PAG members reported that the principal criteria influencing their decision to participate in clinical trials overall are (1) the risks involved, (2) the benefits that will be gained from their potential participation, and (3) the quality and quantity of information provided regarding the trial. The survey revealed that, out of the 520 respondents, 133 individuals across all age groups were "positive" toward registering in the VACCELERATE Volunteer Registry, with an additional 47 individuals reporting being "very positive." Respondents from Northern European countries were 1.725 (95% CI 1.206-2.468) times more likely to be willing to participate in the VACCELERATE Volunteer Registry than respondents from Southern European countries.

CONCLUSIONS

Factors discouraging participants from joining vaccine trial registries or clinical trials primarily include concerns of the safety of novel vaccines and a lack of trust in those involved in vaccine development. These outcomes aid in identifying issues and setbacks in present registries, providing the VACCELERATE network with feedback on how to potentially increase participation and enrollment in trials across Europe. Development of European health communication strategies among diverse public communities, especially via PAGs, is the key for increasing patients' willingness to participate in clinical studies.

Attitudes of healthcare workers toward the COVID-19 vaccine and related factors: A systematic review

AIM AND OBJECTIVES

This systematic review aims to examine healthcare professionals' attitudes toward the COVID-19 vaccine and related factors.

BACKGROUND

Healthcare workers have priority among risky groups accepted as candidates for early vaccination. Therefore, it is important to consider health professionals' attitudes toward COVID-19 vaccination to better address barriers to widespread vaccination.

MATERIALS AND METHODS

Six databases were searched for articles published between January 01, 2020, and February 31, 2022, and 1161 studies were reached. As a result of the evaluations, 10 studies were included in the systematic review. Nine studies are cross-sectional, and one is a descriptive study. A 9-item Critical Appraisal Checklist for Analytical Cross Sectional Studies from the Joanna Briggs Institute MAStARI Critical Assessment Tools (JBI-MAStARI) was used for quality assessment. High-quality studies with an average or higher methodological quality score were included in the systematic review. The PRISMA guideline was followed while selecting studies.

RESULTS

Positive attitudes of healthcare professionals toward the COVID-19 vaccine ranged from 10% to 93.7%, and negative attitudes varied between 6.3% and 41.0%. Factors such as the male gender, being a physician, advanced age, previous influenza vaccination history, and presence of chronic disease were found to be associated with vaccine acceptance. Factors such as doubt about the efficacy of the COVID-19 vaccine, safety concerns, and fear of unknown side effects of the vaccine were associated with COVID-19 vaccine hesitancy.

CONCLUSION

There is a need for confidence-building interventions and tailored communication strategies, including personalized training to change the ambiguous attitudes of healthcare professionals, increase vaccine uptake, and cope with the multifaceted impact of infection.

PROSPERO REGISTRATION NUMBER

CRD42021290482.

Changes in self-reported risky sexual behaviour indicators among adults receiving regular risk reduction counselling and optional initiation of pre-exposure prophylaxis in an HIV vaccine preparedness study in Masaka, Uganda

BACKGROUND

HIV risk reduction counselling may reduce risk-taking behaviours. Yet, concerns remain about risk compensation among individuals initiating pre-exposure prophylaxis (PrEP).

OBJECTIVE

We assessed changes in risky sexual behaviour indicators among HIV vaccine preparedness study participants who received regular risk reduction counselling and referral for PrEP in Masaka, Uganda.

METHODS

Adults (18-39 years) at high risk of HIV infection were enrolled in the study between July 2018 and December 2021. Data were collected on socio-demographic factors (baseline) and self-reported sexual risk behaviours (baseline, six monthly). HIV testing and risk-reduction counselling and referral for PrEP were done quarterly. Participants who had completed at least 1 year of follow-up were included in the analysis. Proportional differences and McNemar chi-square tests were used to assess changes in the prevalence of self-reported risky sexual behaviour indicators between baseline and 1 year. Logistic regression was used to assess the predictors of unchanged/increased HIV risk at 1 year.

RESULTS

Three hundred participants [132 (44%) females, 152 (51%) aged ≤24 years] were included in this analysis. Eighty-one (27%) participants initiated PrEP at 1 year. Compared to baseline, there were significant reductions in the prevalence of the following self-reported HIV risk indicators at 1 year (overall, among non-PrEP initiators, and among PrEP initiators): transactional sex, ≥6 sexual partners, unprotected sex with ≥3 partners, sex while drunk, and sexually transmitted infection diagnosis/treatment. Percentage differences ranged from 10% for individuals reporting at least six sexual partners to 30% for those reporting unprotected sex with three or fewer sexual partners. There was weak evidence of association between female gender and unchanged/increased HIV risk at 1 year (adjusted OR: 1.35, 95% CI (0.84-2.17)). No other indicators, including PrEP use, were associated with unchanged/increased HIV risk at 1 year.

CONCLUSION

Regular risk-reduction counselling may reduce risky sexual behaviour, while PrEP initiation may not lead to risk compensation.

Socio-demographic factors associated with COVID-19 vaccine uptake and refusal among Ugandan women

BACKGROUND

This paper analyzes associations of socio-demographic factors with the uptake of COVID-19 vaccines, the refusal to get vaccinated against COVID-19, and various reasons stated for refusing vaccination against COVID-19 among a representative sample of Ugandan women.

METHODS

This paper utilizes a representative cross-sectional survey collected among women aged 15-49 years in Uganda between September and November 2021. Regression analyses are used to study the associations of a broad range of socio-demographic characteristics with COVID-19 vaccine uptake, refusal of vaccination, and reasons for refusal among the respondents.

RESULTS

4211 women were included in the analysis. 11% of them were vaccinated against COVID-19, 76% were willing to get vaccinated, 13% were unwilling to get vaccinated. Fear of side effects was the most commonly stated reason for refusing vaccination (69%). Factors significantly and positively associated with being vaccinated against COVID-19 were age, higher education, urban residency, having savings, partial instead of complete income loss during the pandemic, and usage of modern contraceptives. Factors significantly and positively associated with refusing vaccination against COVID-19 were urban residency and current pregnancy, while age, having savings, and using modern contraceptives were factors associated with a lower likelihood of refusing vaccination, albeit with varying statistical significance. Few factors were strongly related to the stated reasons for refusing the vaccines; the fear of side effects significantly increased with age, while having received negative information on the vaccines was significantly less common among women with higher education.

CONCLUSIONS

This study documents a low COVID-19 vaccination rate and a high willingness to get vaccinated among Ugandan women. Positive age and education gradients in vaccine uptake point to inequity in access to vaccination, potentially resulting from prioritizations of groups at particularly high risk. Refusal to be vaccinated was relatively low and systematic factors behind vaccine refusal were hardly to be found, even less so for particular reasons given for refusal.

Leadership and international collaboration on COVID-19 research: reducing the North-South divide?

The COVID-19 pandemic triggered unprecedented scientific efforts worldwide and launched several initiatives to promote international cooperation. Because international scientific collaborations between high-income countries (HICs) and low- and middle-income countries (LMICs) are not always balanced, analyzing research leadership helps to understand the global dynamics of knowledge production during COVID-19. In this study, we focused on HIC-LMIC collaborations on COVID-19 research in 469,937 scientific publications during the first 2 years of the pandemic (2020-2021). Co-authorship and authors' affiliation were used to identify international collaborations, according to country income level. The leadership analysis considered the countries of the first and last authors of publications. The results show that (i) most publications with international collaborations (49.3%) involved researchers from HICs and LMICs; (ii) collaborative research between HICs and LMICs addressed relevant public health needs; (iii) HIC-LMIC collaborations were primarily led by researchers from the United States, China, the United Kingdom, and India; (iv) most HIC-LMIC publications (44%) had shared leadership, with research interests linked to national expertise and global interests. This study contributes to the analysis of research collaborations on COVID-19 and sheds light on North-South relations in the production and dissemination of scientific knowledge.

Social capital and willingness to participate in COVID-19 vaccine trials: an Italian case-control study

BACKGROUND

What leads healthy people to enter in a volunteer register for clinical trials? This study aimed to investigate the relationship between the decision to volunteer in clinical trials for a COVID-19 vaccine and social capital, in a sample of healthy volunteers in Italy. Since social capital is characterized by trust, reciprocity, and social and political participation, we claim that it is key in leading individuals to actively take action to protect public health, and to take a risk for the (potential) benefit not only of themselves but for the entire community.

METHODS

This study was conducted through the administration of a questionnaire to healthy volunteers registered for a phase 1 clinical trial for a COVID-19 vaccine in the Unit Research Centre of ASST-Monza, in September 2020. The primary purpose of a phase 1 study is to evaluate the safety of a new drug candidate before it proceeds to further clinical studies. To approximate a case-control study, we randomly matched the 318 respondents to healthy volunteers (cases) with 318 people randomly selected by Round 9 of the European Social Survey (controls), using three variables, which we considered to be associated with the decision to volunteer: gender, age, and education level. To execute this matching procedure, we used the "ccmatch" module in STATA.

RESULTS

The findings highlight the positive impact of social capital in the choice of healthy individuals to volunteer in COVID-19 vaccine clinical trials. Controlling for possible confounding factors, some exemplary results show that people with a high level of general trust have a greater likelihood of volunteering compared to people with low trust (OR = 2.75, CI = 1.58-4.77); we also found that it is more probable that volunteers are people who have actively taken action to improve things compared with people who have not (for individuals who did three or more actions: OR = 7.54, CI = 4.10-13.86). People who reported voting (OR = 3.91, CI = 1.70-8.99) and participating in social activities more than other people of their age (OR = 2.89, CI = 1.82-4.60) showed a higher probability to volunteer.

CONCLUSIONS

Together with the adoption of urgent health measures in response to COVID-19, government policymakers should also promote social capital initiatives to encourage individuals to actively engage in actions aimed at protecting collective health. Our findings make an empirical contribution to the research on vaccines and its intersection with social behaviour, and they provide useful insights for policymakers to manage current and future disease outbreaks and to enhance the enrolment in vaccine trials.

COVID-19 Vaccine Acceptability Among Healthcare Facility Workers in Sierra Leone, the Democratic Republic of Congo and Uganda: A Multi-Centre Cross-Sectional Survey

Objectives: This cross-sectional survey explored COVID-19 vaccine acceptability among public healthcare facility workers in Kambia (Sierra Leone), Goma (Democratic Republic of Congo) and Masaka (Uganda). Methods: Questionnaire-based interviews conducted between April-October 2021 explored participants' knowledge and perceptions of, and attitudes towards, the COVID-19 pandemic and COVID-19 vaccines, as well as COVID-19 vaccine acceptability (defined as uptake of ≥1 dose or intent to get vaccinated). Results: Whilst most (n = 444; 81.8%) of the 543 participants had one or more concerns about COVID-19 vaccines, 487 (89.7%) nonetheless perceived that they were important for pandemic control. Most participants from Kambia or Masaka either were vaccinated (n = 137/355; 38.6%) or intended to get vaccinated (n = 211/355; 59.4%) against COVID-19. In Goma, all 188 participants were unvaccinated; only 81 (43.1%) participants intended to get vaccinated, and this was associated with positive perceptions about COVID-19 vaccines. In Goma, the most common reasons for not wanting a COVID-19 vaccine were concerns that the vaccines were new (n = 75/107; 70.1%) and fear of side effects (n = 74/107; 69.2%). Conclusion: Reported COVID-19 vaccine acceptability was high among healthcare facility workers in Kambia and Masaka. The lower vaccine acceptability in Goma may highlight the importance of social mobilisation and accurate, accessible information that addresses specific concerns.

Why not? Motivations for entering a volunteer register for clinical trials during the COVID-19 pandemic

Backgrounds

Healthy volunteers play a key role in clinical trials and it is crucial to develop recruitment strategies that capitalise on their motivations and maximise their participation. The COVID-19 pandemic has shown the importance of finding motivated healthy volunteers for the development of new vaccines. Public registers represent a promising way to promote the participation of healthy volunteers in the research field, but their adoption is still limited. The current study aimed to explore the motivations of healthy volunteers to enrol in an Italian public register for clinical trials during the COVID-19 pandemic and their attitude toward participating in a phase 1 COVID-19 vaccine clinical trial. The impacts of different enrolling interview modalities (in person, by phone, by mail) on motivation, understanding of information and trust in researchers were also investigated.

Methods

An online survey investigating experience with COVID-19, motivations to enrol, trust in researchers, political and healthcare authorities and pharmacological companies was presented to people applying as healthy volunteers in the public register for clinical trials at Phase 1 Unit Research Centre of ASST Monza, Italy, and considering to participate in a COVID-19 vaccine clinical trial. Data were collected in June 2021.

Results

Altruistic motivations were the main driver for enrolling in the public register, while self-interested motivations were secondary. No gender differences were found. As for enrolling modalities, no differences emerged between in-person and interviews for motivation to enrol, understanding of information and trust in researchers. Email modality led to significantly lower volunteers’ satisfaction and understanding of information but similar trust in research.

Conclusions

This study supports the validity of different interview modalities (in person and by phone) for the enrolment of healthy volunteers for clinical trials and highlights the positive role of public registers for the recruitment procedures.

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India

Background

Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers’ willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India.

Methods

A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine.

Results

Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18–7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51–8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24–4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17–4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12–0.88), p = 0.027].

Conclusions

Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

Intention to participate in COVID-19 vaccine clinical trials in May 2021: a cross-sectional survey in the general French population

In May 2021, while the immunization campaign was in progress, the emergence of new SARS-CoV-2 variants led us to assess attitudes toward participation in a COVID-19 vaccine clinical trial (VCT) in France. Between the 10th and the 23rd of May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over and a specific sample of the French population over 65. Among the 3,056 respondents, 28.0% (856) would consider participation in a COVID-19 VCT. Factors independently negatively associated with willingness to participate in a COVID-19 VCT were female gender with an adjusted odd ratio (aOR) 0.42 and 95% confidence interval (95% CI) 0.35–0.51, and mistrust in health actors (in their own physician and pharmacists, health ministry, government, scientists in medias, medias and pharmaceutical companies) with aOR 0.86 (95% CI 0.84–0.88) by one-point increase in mistrust in health actors score. Factors positively associated with willingness to participate in a COVID-19 VCT were COVID-19 vaccination or intention to get vaccinated with aOR 4.89 (95% CI 3.15–7.61), being a healthcare worker with aOR 2.051 (95% CI 1.51–2.80), being at risk for severe COVID-19 with aOR 1.39 (95% CI 1.14–1.69) and altruism as the main reason for getting vaccination with aOR 1.56 (95% CI 1.29–1.88). In May 2021, despite COVID 19 vaccine availability, 28% of the French population would agree to participate in a COVID-19 VCT. Mistrust in health actors contributes to a reduction in the intention to participate. Attitudes toward COVID-19 vaccination predict attitudes toward participation in a COVID-19 VCT.

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

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

High COVID-19 Vaccine Acceptance among Eye Healthcare Workers in Uganda

Background: Protecting healthcare workers against COVID-19 disease is crucial, and COVID-19 vaccination is the most effective method to do so. Eye healthcare workers provide routine care in proximity, increasing infection risk, hence their need for full vaccination. This study determined COVID-19 vaccine acceptance and barriers to its uptake among eye healthcare workers practicing in Uganda. Methods: This was a cross-sectional online and telephone survey based on the health belief model (HBM), conducted in June–August 2021. A modified Poisson regression model with robust standard errors was used to determine the factors associated with COVID-19 vaccine acceptance. Results: In total, 300 (85%) of the 357 eye healthcare workers participated in the study with mean age 43 ± 8 years and 182 (60.7%) were men. Overall, 97.6% (95% CI: 95.9–99.4) had accepted and/or were willing to take the COVID-19 vaccine, 65.3% had received a shot of the COVID-19 vaccine, and 97 (32.3%) reported the intention to accept the vaccine when it became available. Among the HBM constructs, high perceived susceptibility and high perceived benefits were significantly associated with COVID-19 vaccine acceptance. Conclusions: The acceptance of the COVID-19 vaccine among eye healthcare workers in Uganda is very high. There is a dire need to make vaccines available to developing nations like Uganda.

COVID-19 Vaccine Acceptance among Low- and Lower-Middle-Income Countries: A Rapid Systematic Review and Meta-Analysis

Widespread vaccination against COVID-19 is critical for controlling the pandemic. Despite the development of safe and efficacious vaccinations, low-and lower-middle income countries (LMICs) continue to encounter barriers to care owing to inequitable access and vaccine apprehension. This study aimed to summarize the available data on COVID-19 vaccine acceptance rates and factors associated with acceptance in LMICs. A comprehensive search was performed in PubMed, Scopus, and Web of Science from inception through August 2021. Quality assessments of the included studies were carried out using the eight-item Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies. We performed a meta-analysis to estimate pooled acceptance rates with 95% confidence intervals (CI). A total of 36 studies met the inclusion criteria and were included in the review. A total of 83,867 respondents from 33 countries were studied. Most of the studies were conducted in India (n = 9), Egypt (n = 6), Bangladesh (n = 4), or Nigeria (n = 4). The pooled-effect size of the COVID-19 vaccine acceptance rate was 58.5% (95% CI: 46.9, 69.7, I2 = 100%, 33 studies) and the pooled vaccine hesitancy rate was 38.2% (95% CI: 27.2-49.7, I2 = 100%, 32 studies). In country-specific sub-group analyses, India showed the highest rates of vaccine acceptancy (76.7%, 95% CI: 65.8-84.9%, I2= 98%), while Egypt showed the lowest rates of vaccine acceptancy (42.6%, 95% CI: 16.6-73.5%, I2= 98%). Being male and perceiving risk of COVID-19 infection were predictors for willingness to accept the vaccine. Increasing vaccine acceptance rates in the global south should be prioritized to advance global vaccination coverage.

COVID-19 vaccine uptake among health care workers in Ghana: a case for targeted vaccine deployment campaigns in the global south

BACKGROUND

Health care workers (HCWs) are among the high-risk groups in contracting and dying from COVID-19. World Health Organization estimates that over 10,000 HCWs in Africa have been infected with COVID-19 making it a significant occupational health hazard to HCWs. In Ghana, over 100 HCWs have already been infected and dozen others died from the virus. Acceptability and uptake of the COVID-19 vaccine is therefore critical to promote health and safety of HCWs as the country battles out of a third wave of the pandemic.

OBJECTIVE

The study sought to ascertain the correlates of HCWs likelihood of participating in a COVID-19 vaccine trial and accepting the vaccine when given the opportunity.

METHODS

The study was a web-based cross-sectional survey among HCWs (n = 1605) in all sixteen (16) administrative regions in Ghana. Data were analyzed with STATA statistical analysis software (version 14). Chi-square (X2) and Fisher's exact tests were used to test for differences in categorical variables; bivariate probit regression analysis with Average Marginal Effect (AME) was employed to ascertain the determinants of HCWs' likelihood of participating in a COVID-19 vaccine trial and taking the vaccine.

RESULTS

It was found that 48% of HCWs will participate in a COVID-19 vaccine trial when given the opportunity; 70% will accept the COVID-19 vaccine; younger HCWs (AME = 0.28, SE = 0.16, p < 0.1), non-Christians (AME = 21, SE = 0.09, p < 0.05) and those who worked in faith-based health facilities (AME = 18, SE = 0.07, p < 0.05) were more likely to participate in a COVID-19 vaccine trial. Female HCWs (AME = - 11, SE = 0.04, p < 0.05) and those with lower educational qualification were less likely to accept a COVID-19 vaccine (AME = - 0.16, SE = 0.08, p < 0.1). Reasons cited for unwillingness to participate in a COVID-19 vaccine trial or uptake the vaccine were mainly fear, safety concerns, mistrust, uncertainty, spiritual and religious beliefs.

CONCLUSIONS

Acceptance of the COVID-19 vaccine appear to be high among HCWs; conversely, willingness to volunteer for the vaccine trial was low. Continuous targeted and integrated public health education for HCWs will enhance vaccine acceptability to promote safety and population health in the global south as Ghana intensifies efforts to produce COVID-19 vaccines locally.

Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review

BACKGROUND

High rates of vaccination worldwide are required to establish a herd immunity and stop the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide.

METHODS

A systematic literature search of PubMed and Web of Science was performed on July 5th, 2021, using developed keywords. Inclusion criteria required the study to (1) be conducted in English; (2) investigate attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; (3) utilize validated measurement techniques; (4) have the full text paper available and be peer-reviewed prior to final publication.

FINDINGS

Following PRISMA guidelines, 209 studies were included. The Newcastle Ottawa (NOS) scale for cross-sectional studies was used to assess the quality of the studies.Overall, vaccine acceptance rates ranged considerably between countries and between different time points, with Arabian countries showing the highest hesitancy rates compared with other parts of the world.

INTERPRETATION

A variety of different factors contributed to increased hesitancy, including having negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, living in a rural area, and self-identified as a racial/ethnic minority.