Determinants of the COVID-19 vaccine hesitancy spectrum

Determinants of COVID-19 vaccine acceptance and hesitancy among adolescents and youths aged 10-35 years in sub-Saharan African countries: A systematic review and meta-analysis

The COVID-19 pandemic has overwhelmed health systems, especially in sub-Saharan African countries. Vaccination is one of the easily accessible interventions that can help reduce the burden on the health system. However, vaccination coverage remains low in sub-Saharan African countries. The determinants of vaccine acceptance and hesitancy among adolescents and youths remain unknown. Therefore, this study explored the pooled prevalence and determinants of COVID-19 vaccine acceptance and hesitancy among adolescents and youths in sub-Saharan African Countries. A systematic literature search of Scopus, PubMed Central, PubMed, Embase, African Journal Online, Research 4 Life, Embase, and Google Scholar was performed from 6th May to 31st December 2023, using developed keywords with a focus on sub-Saharan African countries. Twenty-three (N = 23) studies were finally selected for analysis. The pooled prevalence of vaccine acceptance among adolescents and youths was 38.7% (n = 23). The subgroup analysis of the pooled prevalence of acceptance among adolescents was 36.1% (n = 36.1) while youths were 42% (n = 10). At the region level, West Africa had 42.2% (n = 13), East Africa had 39.8% (n = 6), Central Africa had 33% (n = 1), and Southern Africa had 24.2% (n = 3). The determinants of vaccine acceptance were the desire for self-immunity (AOR = 1.97, 95%, CI, 1.083.47, I2 = 94.15%, p < 0.05), receiving Health Officers' information (AOR = 4.36, 95%, CI, 2.28-8.32, I2 = 97.74, p < 0.001), the effectiveness of COVID-19 vaccine (AOR = 2.14, 95%, CI, 1.14-4.05, I2 = 97.4%, p < 0.05). The odds of having an unconfirmed source of information (AOR = 0.22, 95% CI, 0.10-0.45, I2 = 94.09%, p< 0.001) was responsible for vaccine hesitancy. The findings indicate the low pooled prevalence of COVID-19 vaccine acceptance and high levels of hesitancy among adolescents and youths in sub-Saharan African countries. Therefore, there is a need to ensure that extensive research is undertaken into age-appropriate health promotion messages and strategies to encourage the uptake of vaccines. PROSPERO ID number CRD42023403071.

A Majority Of Americans Have No Or Low Awareness Of Paxlovid, The At-Home COVID-19 Treatment

Oral Paxlovid (nirmatrelvir-ritonavir) is highly effective at preventing hospitalization and death from COVID-19, yet it has been remarkably underused, even by patients at highest risk from COVID-19, since its December 2021 introduction in the US. The reasons behind this underuse are still unclear. To examine public awareness and perceptions of Paxlovid that might help explain its underuse, we conducted a nationally representative survey of 1,430 US adults in July 2023. A majority of respondents (85 percent) had no or low awareness of Paxlovid, including 31 percent who had never heard of it. Even among those who were aware of the drug, many held misperceptions about its effectiveness (39 percent), adverse effects (86 percent), and requisite timing (61 percent) that could lead to underuse. Lower awareness and misperceptions were more common among medically vulnerable and disadvantaged populations who might benefit most from Paxlovid access, including adults unvaccinated against COVID-19, those with lower levels of education, and Black and Hispanic or Latino adults. Results suggest that Paxlovid underuse may be partly driven by a lack of effective public communication to generate awareness and knowledge about the drug, leading to low demand. As Paxlovid loses full government subsidies, further public outreach is needed to ensure that the public accesses it when needed.

Public Willingness to Mask and Vaccinate in the Future: Results From a 2023 Nationally Representative Survey of US Adults

The enduring spread of COVID-19 and other respiratory viruses highlights a need for greater focus on long-term public willingness to perform protective behaviors. Although COVID-19 is no longer considered a public health emergency of international concern, it is unknown whether people in the United States plan to continue protective behaviors to protect themselves and others against infection. To inform planning and communications, we used a nationally representative survey of 1,936 US adults to examine attitudes and intentions toward future vaccination and mask-wearing. A majority believed COVID-19 vaccines were safe (73%) and effective in protecting against serious illness (72%). One-third (33%) had strong intentions to get an updated COVID-19 vaccine most years in the future. Among those with weaker intentions (n=1,287), many cited concerns about safety (71%) and efficacy (64%), lack of trust in institutions (64%), or beliefs that prior vaccination or infection protected them (62%). Approximately two-thirds (69%) of respondents believed masks were effective in protecting the wearer from getting COVID-19, and a majority appeared moderately receptive to future public mask-wearing, particularly when there was proximate risk of infection from COVID-19 (67%) or other respiratory viruses (59%). Men, non-Hispanic White adults, younger adults, rural residents, and adults with higher incomes, without college degrees, and without serious medical conditions or physical limitations were more likely to indicate resistance toward future COVID-19 vaccination and/or mask-wearing. Findings support tailored messaging to address concerns and opportunities among different populations, as well as support for communications programs and community engagement to motivate future uptake.

Vaccine Uptake and Intentions: Insights from a Texas Survey on Factors Influencing COVID-19 Vaccination Decisions

The effectiveness of COVID-19 vaccines depends on widespread vaccine uptake. Employing a telephone-administered weighted survey with 19,502 participants, we examined the determinants of COVID-19 vaccine acceptance among adults in Texas. We used multiple regression analysis with LASSO-selected variables to identify factors associated with COVID-19 vaccine uptake and intentions to receive the vaccine among the unvaccinated. The prevalence of unvaccinated individuals (22%) was higher among those aged 18-39, males, White respondents, English speakers, uninsured individuals, those facing financial challenges, and individuals expressing no concern about contracting the illness. In a fully adjusted regression model, higher odds of being unvaccinated were observed among males (aOR 1.11), the uninsured (aOR 1.38), smokers (aOR 1.56), and those facing financial struggles (aOR 1.62). Conversely, Asians, Blacks, and Hispanics were less likely to be unvaccinated compared to Whites. Among the unvaccinated, factors associated with stronger intent to receive the vaccine included age (over 65 years), Black and Hispanic ethnicity, and perceived risk of infection. Hispanic individuals, the uninsured, those covered by public insurance, and those facing financial challenges were more likely to encounter barriers to vaccine receipt. These findings underscore the importance of devising tailored strategies, emphasizing nuanced approaches that account for demographic, socioeconomic, and attitudinal factors in vaccine distribution and public health interventions.

Investigating the Spatial Accessibility and Coverage of the Pediatric COVID-19 Vaccine: An Ecologic Study of Regional Health Data

The COVID-19 pandemic presented the unique challenge of having to deliver novel vaccines during a public health crisis. For pediatric patients, it was further complicated by the delayed timeline for authorizing the vaccine and the differences in dosing/products depending on the patient's age. This paper investigates the relationship between the spatial accessibility and uptake of the COVID-19 vaccine in King County, WA, USA. Public data for COVID-19 vaccine sites were used to calculate spatial accessibility using an enhanced two-step floating catchment area (E2SFCA) technique. Spatial regression analyses were performed to look at the relationship between spatial accessibility and ZIP-code-level vaccination rates. The relationships of these data with other socioeconomic and demographic variables were calculated as well. Higher rates of vaccine accessibility and vaccine coverage were found in adolescent (12- to 17-year-old) individuals relative to school-age (5- to 11-year-old) individuals. Vaccine accessibility was positively associated with coverage in both age groups in the univariable analysis. This relationship was affected by neighborhood educational attainment. This paper demonstrates how measures such as E2SFCA can be used to calculate the accessibility of the COVID-19 vaccine in a region and provides insight into some of the ecological factors that affect COVID-19 vaccination rates.

Trait and situation-specific intolerance of uncertainty predict affective symptoms during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic, a high-uncertainty situation, presents an ideal opportunity to examine how trait intolerance of uncertainty (IU) and situation-specific IU relate to each other and to mental health outcomes. The current longitudinal study examined the unique associations of trait and COVID-specific IU with general distress (anxiety and depression) and pandemic-specific concerns (pandemic stress and vaccine worry).

METHODS

A community sample of Florida adults (N = 2152) was surveyed online at three timepoints. They completed measures of trait IU at Wave 1 (April-May 2020) and COVID-specific IU at Wave 2 (May-June 2020). At Wave 3 (December-February 2021), they reported symptoms of depression, anxiety, pandemic stress, and vaccine worry.

RESULTS

We used structural equation modeling to test our overall model. Trait IU significantly predicted later COVID-specific IU, however there was no significant effect of trait IU on any outcome measure after accounting for COVID-specific IU. Notably, COVID-specific IU fully mediated the relationship between trait IU and all four symptom measures.

LIMITATIONS

There were several limitations of the current study, including the use of a community sample and high participant attrition.

CONCLUSIONS

Results suggest that COVID-specific IU predicts mental health outcomes over and above trait IU, extending the existing literature. These findings indicate that uncertainty may be more aversive when it is related to specific distressing situations, providing guidance for developing more specific and individualized interventions. Idiographic treatments which target situation-specific IU may be more efficacious in reducing affective symptoms and related stress during the COVID-19 pandemic or other similar events.

COVID-19 Vaccine Information Seeking Patterns and Vaccine Hesitancy: A Latent Class Analysis to Inform Practice

CONTEXT

Throughout the COVID-19 pandemic, state and local health departments served as risk communicators to the public; however, public health practitioners have limited resources at their disposal when trying to communicate information, especially when guidance is rapidly changing. Identifying how the population gathers information across channels and which subsets of the population utilize which channels can help practitioners make the best use of these limited resources.

OBJECTIVE

To identify how individuals utilized different information channels to get COVID-19-related information and determine its effect on one COVID-19-related action: vaccine intentions.

DESIGN

This study applies latent class analysis to utilization of information channels to characterize information consumption patterns during the COVID-19 infodemic and then explores the relationship between these patterns and vaccine hesitancy.

SETTING

The data were collected from the COVID-19 Vaccine Hesitancy Survey , which is a nationally representative sample of US adults 18 years and older recruited from Social Science Research Solutions (SSRS)'s Opinion Panel.

PARTICIPANTS

The online survey was conducted between April 7 and April 11, 2021, after the COVID-19 vaccine was available to all adults and enrolled more than 3000 respondents (n = 3014).

MAIN OUTCOME MEASURES

Respondents were asked about their frequency of information seeking related to the COVID-19 vaccine, sociodemographics, and vaccine perceptions.

RESULTS

Based on fit statistics and prior research, we identified 6 latent classes that characterize information seeking: Nonseekers, Legacy, Legacy + Facebook/Instagram, Traditional Omnivore, Omnivore + Broad Social Media, and Twitter. Sociodemographics, political, economic, and COVID-19 exposure variables are associated with different patterns of seeking information about COVID-19. Membership in 3 of these classes was associated with higher rates of vaccine refusal and vaccine hesitancy.

DISCUSSION

The study has implications for public health officials and policymakers who use media channels to share news and health information with the public. Information should be tailored to the sociodemographic profiles of those users who are likely consuming information across multiple different channels.

Assortative mixing of opinions about COVID-19 vaccination in personal networks

Many countries worldwide had difficulties reaching a sufficiently high vaccination uptake during the COVID-19 pandemic. Given this context, we collected data from a panel of 30,000 individuals, which were representative of the population of Romania (a country in Eastern Europe with a low 42.6% vaccination rate) to determine whether people are more likely to be connected to peers displaying similar opinions about COVID-19 vaccination. We extracted 443 personal networks, amounting to 4430 alters. We estimated multilevel logistic regression models with random-ego-level intercepts to predict individual opinions about COVID-19 vaccination. Our evidence indicates positive opinions about the COVID-19 vaccination cluster. Namely, the likelihood of having a positive opinion about COVID-19 vaccination increases when peers have, on average, a more positive attitude than the rest of the nodes in the network (OR 1.31, p < 0.001). We also found that individuals with higher education and age are more likely to hold a positive opinion about COVID-19 vaccination. With the given empirical data, our study cannot reveal whether this assortative mixing of opinions is due to social influence or social selection. However, it may nevertheless have implications for public health interventions, especially in countries that strive to reach higher uptake rates. Understanding opinions about vaccination can act as an early warning system for potential outbreaks, inform predictions about vaccination uptake, or help supply chain management for vaccine distribution.

Alike but not the same: Psychological profiles of COVID-19 vaccine skeptics

One of the challenges of the SARS-CoV-2 pandemic was a widespread skepticism about vaccination. To elucidate the underlying mental and emotional predispositions, we examined a sample of 1428 participants using latent profile analysis (LPA) on selected personality trait variables, mental health status, and measures of irrational beliefs. LPA revealed five distinct profiles: two classes of non-skeptics and three of skeptics. The smaller non-skeptic class reported the highest rates of mental health problems, along with high levels of neuroticism, hostility, interpersonal sensitivity, and external locus of control. The larger non-skeptic class was psychologically well-balanced. Conversely, the skeptic groups shared strong distrust of COVID-19 vaccination but differed in emotional and mental profiles, leading to graded differences in endorsing extreme conspiracy beliefs. This suggests that vaccine skepticism is not solely a result of mental illness or emotional instability; rather extreme skepticism manifests as a nuanced, graded phenomenon contingent on personality traits and conspirational beliefs.

COVID-19 vaccine hesitancy among pregnant women attending public antenatal clinics in Dar es Salaam, Tanzania

The COVID-19 pandemic has claimed over six million lives and caused significant morbidities globally. The development and use of COVID-19 vaccines is a key strategy in ending this. There is a general public hesitancy on vaccine uptake, including pregnant women who are at high risk of severe forms of the disease and death when infected with the virus. To determine the magnitude of hesitancy toward COVID-19 vaccines and the associated factors among pregnant women attending public antenatal clinics in Dar es Salaam‬. This was a cross-sectional analytical study conducted among 896 pregnant women attending antenatal clinics at public health facilities in Dar es Salaam. A structured interviewer-based questionnaire, in an electronic form, was used. The analysis was done by a multivariable linear regression model using STATA 16 to obtain factors associated with vaccine hesitancy, and P < .05 was considered significant. The proportion of pregnant women with vaccine hesitancy was 45%. Hesitancy was higher among unemployed pregnant women (AOR 2.16 (95% CI 1.36-3.42) and the self-employed group (AOR 1.62 (95% CI 1.07-2.44). It was also higher among pregnant women with poor attitudes to COVID-19 vaccines (AOR 2.44 (95% CI 1.75-3.39) and women who had low perceived benefits of the vaccines (AOR 2.57 (95% CI 1.83-3.60). COVID-19 vaccine-targeted interventions should aim at the provision of knowledge on COVID-19 and the COVID-19 vaccine and address poor attitudes and perceptions that pregnant women have on these vaccines.

Novel COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students: a scoping review

Medical students are likely to be exposed to COVID-19 patients so achieving high vaccination coverage rates for this group of healthcare workers is important, as is their potential as vaccination role models. The aim of this scoping review was to evaluate the current literature to determine the rates of COVID-19 vaccine hesitancy and acceptance, and associated factors, amongst medical students. Systematic searches of the Medline Ovid, Embase, PubMed, and Education Resources Information Centre (ERIC) online databases was conducted for relevant articles with keywords: 'COVID-19', 'vaccine hesitancy & acceptance' and 'medical students'. Articles were included for review if they reported the rates of vaccine hesitancy and acceptance, and associated factors, amongst medical students. Of the 258 articles identified, 52 met the inclusion criteria and underwent full-text review. Rates of vaccine hesitancy ranged from 5.4-86.7%, with generally positive attitudes towards COVID-19 vaccination. The main factors associated with vaccine hesitancy were concerns about the safety and efficacy of vaccines due to their accelerated development, being a pre-clinical medical student, and low perceived personal risk of COVID-19 infection. Inconsistencies were found for the influence of gender on attitudes towards vaccinations. Previous vaccination behaviours were predictive of willingness to receive the COVID-19 vaccine. Knowledge about COVID-19 vaccinations and their importance was found to be deficient amongst vaccine hesitant medical students. Generally, medical students express low levels of vaccine hesitancy. However, due to the variability in the factors associated with vaccine hesitancy across different populations and the dynamic and contextual nature of hesitancy, it is recommended that vaccination intent and associated attitudes are monitored on a longitudinal basis. It is important to map vaccine hesitancy at a local level to allow medical schools to develop strategies to encourage vaccination specific to their school's needs.

Perceptions of COVID-19 vaccine side effects by political affiliation

BACKGROUND

We sought to assess the extent to which subjective experiences of COVID-19 vaccine side effects among US adults are associated with political party identification.

METHODS

An online survey was conducted of a national sample of US adults (N = 1259) identifying as either Republican or Democrat.

RESULTS

There was no significant difference by party identification in the perceived severity of vaccination side effects; however, Republicans were significantly less likely to recommend the vaccine to others in light of their experience (OR = 0.40; 95% CI, 0.31-0.51; P < 0.001). Republicans also reported having a larger share of COVID-19-vaccinated friends and family who experienced notable side effects (OR = 1.31; 95% CI, 1.02-1.68; P < 0.05). There was a positive association between respondents' perceived side-effect severity and the proportion of peers who also reported notable side effects (r = 0.43; P < 0.001).

CONCLUSION

Subjective appraisals of the vaccinated may affect broader vaccine acceptability.

Associations between COVID-19 Death Exposure and COVID-19 Vaccine Hesitancy and Vaccine Uptake

OBJECTIVES

The aim of the study was to determine the relation between coronavirus disease 2019 (COVID-19) death exposure and COVID-19 vaccine hesitancy and vaccine uptake among Arkansans, controlling for sociodemographic factors.

METHODS

Data were collected from a telephone survey administered in Arkansas between July 12 and July 30, 2021 (N = 1500) via random digit dialing of telephone landlines and cellular telephones. Weighted data were used to estimate regressions.

RESULTS

Controlling for sociodemographic variables, COVID-19 death exposure was not a significant predictor of COVID-19 vaccine hesitancy (P = 0.423) or COVID-19 vaccine uptake (P = 0.318). Younger individuals, those with lower levels of education, and those who live in rural counties were more likely to be COVID-19 vaccine hesitant. Older individuals, Hispanic/Latinx individuals, those who reported higher levels of education, and those who reported living in urban counties were more likely to have reported receiving the COVID-19 vaccine.

CONCLUSIONS

Many efforts to promote COVID-19 vaccines have focused on prosocial norms, including encouraging vaccination to protect the community from COVID-19 infection and death; however, COVID-19 death exposure was not related to COVID-19 vaccine hesitancy or uptake in the present study. Future research should examine whether prosocial messaging is effective in decreasing hesitancy or motivating some individuals to receive the vaccine among those who have been exposed to COVID-19 deaths.

COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study

High COVID-19 vaccine hesitancy in South Africa limits protection against future epidemic waves. We evaluated how vaccine hesitancy and its correlates evolved April 2021-April 2022 in a well-characterized rural KwaZulu-Natal setting. All residents aged >15 in the Africa Health Research Institute's surveillance area were invited to complete a home-based, in-person interview. We described vaccine uptake and hesitancy trends, then evaluated associations with pre-existing personal factors, dynamic environmental context, and cues to action using ordinal logistic regression. Among 10,011 respondents, vaccine uptake rose as age-cohorts became vaccine-eligible before levelling off three months post-eligibility; younger age-groups had slower uptake and plateaued faster. Lifetime receipt of any COVID-19 vaccine rose from 3.0% in April-July 2021 to 32.9% in January-April 2022. Among 7,445 unvaccinated respondents, 47.7% said they would definitely take a free vaccine today in the first quarter of the study time period, falling to 32.0% in the last. By March/April 2022 only 48.0% of respondents were vaccinated or said they would definitely would take a vaccine. Predictors of lower vaccine hesitancy included being male (adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.65-0.76), living with vaccinated household members (aOR:0.65, 95%CI: 0.59-0.71) and knowing someone who had had COVID-19 (aOR: 0.69, 95%CI: 0.59-0.80). Mistrust in government predicted greater hesitancy (aOR: 1.47, 95%CI: 1.42-1.53). Despite several COVID-19 waves, vaccine hesitancy was common in rural South Africa, rising over time and closely tied to mistrust in government. However, interpersonal experiences countered hesitancy and may be entry-points for interventions.

What accounts for the variation in COVID-19 vaccine hesitancy in Eastern, Southern and Western Europe?

In the wake of mass COVID-19 vaccination campaigns in 2021, significant differences in vaccine skepticism emerged across Europe, with Eastern European countries in particular facing very high levels of vaccine hesitancy and refusal. This study investigates the determinants of COVID-19 vaccine hesitancy and refusal, with a focus on these differences across Eastern, Southern and Western Europe. The statistical analyses are based on individual-level survey data comprising quota-based representative samples from 27 European countries from May 2021. The study finds that demographic variables have complex associations with vaccine hesitancy and refusal. The relationships with age and education are non-linear. Trust in different sources of health-related information has significant associations as well, with people who trust the Internet, social networks and 'people around' in particular being much more likely to express vaccine skepticism. Beliefs in the safety and effectiveness of vaccines have large predictive power. Importantly, this study shows that the associations of demographic, belief-related and other individual-level factors with vaccine hesitancy and refusal are context-specific. Yet, explanations of the differences in vaccine hesitancy across Eastern, Southern and Eastern Europe need to focus on why levels of trust and vaccine-relevant beliefs differ across regions, because the effects of these variables appear to be similar. It is the much higher prevalence of factors such as distrust of national governments and medical processionals as sources of relevant medical information in Eastern Europe that are relevant for explaining the higher levels of vaccine skepticism observed in that region.

Parents' perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis

BACKGROUND

Uptake of the SARS-CoV-2 vaccine for children aged 5-11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, parental decisions regarding vaccinations have not been studied in-depth. We sought to explore reasons why parents chose to vaccinate or not vaccinate their children against SARS-CoV-2 to better understand their decisions.

METHODS

We conducted a qualitative study involving in-depth individual interviews with a purposive sample of parents in the Greater Toronto Area, Ontario, Canada. We conducted interviews via telephone or video call from February to April 2022 and analyzed the data using reflexive thematic analysis.

RESULTS

We interviewed 20 parents. We found that parental attitudes toward SARS-CoV-2 vaccinations for their children represented a complex continuum of concern. We identified 4 cross-cutting themes: the newness of SARS-CoV-2 vaccines and the evidence supporting their use; the perceived politicization of guidance for SARS-CoV-2 vaccination; the social pressure surrounding SARS-CoV-2 vaccinations; and the weighing of individual versus collective benefits of vaccination. Parents found making a decision about vaccinating their child challenging and expressed difficulty sourcing and evaluating evidence, determining the trustworthiness of guidance, and balancing their own conceptions of health care decisions with societal expectations and political messaging.

INTERPRETATION

Parents' experiences making decisions regarding SARS-CoV-2 vaccination for their children were complex, even for those who were supportive of SARS-CoV-2 vaccinations. These findings provide some explanation for the current patterns of uptake of SARS-CoV-2 vaccination among children in Canada; health care providers and public health authorities can consider these insights when planning future vaccine rollouts.

Effect of Health Insurance Uptake on Hesitancy toward COVID-19 Vaccines in Nigeria: A Recursive Bivariate Probit and Decomposition Estimation

Moral hazard remains one of the major challenges of health insurance administration. This paper recursively analyzed the effect of health insurance on the willingness to take COVID-19 vaccines in Nigeria. The data comprised 1892 unvaccinated respondents in the 2021/2022 National Longitudinal Phone Survey (NLPS). The data were analyzed with Coban's recursive probit regression and decomposition approaches. The results revealed that 5.87% were health insured, and 7.93% were willing to take COVID-19 vaccines. Health insurance uptake significantly increased (p < 0.05) with an adult being the decision-maker on vaccination, requiring family planning, and urban residence, while it reduced with loss of jobs and residence in the southeast and southwest zones. In addition, health insurance significantly (p < 0.01) increased the willingness to take COVID-19 vaccines, along with each adult, all adults, and households' heads being the major vaccination decision-makers, loss of jobs, and support for making COVID-19 vaccines compulsory. The average treatment effects (ATEs) and average treatment effect on the treated (ATET) of health insurance were significant (p < 0.01), with positive impacts on willingness to be vaccinated. It was concluded that policy reforms to promote access to health insurance would enhance COVID-19 vaccination in Nigeria. In addition, hesitancy toward COVID-19 vaccines can be reduced by targeting adults and household heads with adequate information, while health insurance uptake should target southern states and rural areas.

Toward a meta-vaccine future: Promoting vaccine confidence in the metaverse

The metaverse has a promising role to serve as a global platform and tackle one of the most intractable public health challenges; vaccine hesitancy. Active efforts in this field can enhance vaccine acceptance thus leading to better community health protection. By embracing digital health innovations, the metaverse potentially creates an interactive environment for interdisciplinary collaborations that can foster novel approaches in tackling vaccine hesitancy as well as future pandemics. This paper aims to highlight the unique areas where the metaverse can enhance vaccination confidence, educate about vaccine working principles, and offer collaborative healthcare initiatives in this virtual community.

The role of social value orientation in modulating vaccine uptake in the COVID-19 pandemic: A cross-sectional study

COVID-19 vaccination is the only pharmaceutical measure available to control the pandemic and move past the current crisis. As such, the Maldives, a small island country, invested heavily on securing and vaccinating the eligible population through an intensive risk communication campaign to create awareness on vaccination benefits. This paper reports on the vaccine coverage after a year of COVID-19 vaccine being introduced into the country, based on data obtained from the Values in Crisis Survey - Wave Two among Maldivian adults (n = 497). The findings show a vaccine coverage of 94%, with only 2.2% of the respondents indicating they will not get vaccinated. No significant differences were observed by age, gender, income earning, educational status or residential area. No significant relationship was observed in vaccine behaviour and confidence in government, health sector and experts. Social value orientations, particularly conservation and self-transcendence value orientations determined positive vaccine behaviour (r _s  = 0.180, p < 0.01 and 0.136 p < 0.01 respectively), yet conservation was the only predictor that contributed significantly to the regression model (B = 0.158, p < 0.01). The findings indicate that, despite the uncertainties around COVID-19 vaccinations, the prosocial value orientations were instrumental in achieving a high COVID-19 vaccine coverage. Further theoretical and conceptual exploration of vaccine behaviour in crisis situations is needed to inform future pandemic situations. The vaccination rollout and behaviour change strategies also need an examination of social value orientations in order to achieve a high coverage and sustain pro-vaccine behaviour post-pandemic.

Parental perceptions of the COVID-19 vaccine for 5- to 11-year-old children: Focus group findings from Worcester Massachusetts

Vaccine hesitancy is a long-standing public health issue. The present work describes parental perceptions of COVID-19 vaccination for 5- to 11-year-old children, to aid in vaccination efforts. Parents of 5- to 11-year-old children residing in Worcester, Massachusetts, were recruited through community partner outreach to participate in semi-structured focus groups. Focus groups were conducted via Zoom in English (n = 4) and Spanish (n = 3) with a total of 67 parents. Rapid qualitative analysis was used. Most participants were female and of Hispanic ethnicity. Themes included: (1) Trusted sources and influential types of information (e.g. personal COVID-19 vaccine stories from peers and healthcare providers), (2) Motivations for vaccination: health (i.e. protecting children, families, and communities from COVID-19), (3) Motivations for vaccination: social, emotional, and educational (i.e. mitigating related negative effects of COVID-19), (4) Drivers of vaccine hesitancy (e.g. frustration, uncertainty, and confusion), (5) Differentiating vaccine acceptance, hesitancy, and resistance, (6) Needed information. Although this context may be unique to parents of 5- to 11-year-old children from Central Massachusetts, especially those who may be Spanish-speaking, or of Hispanic ethnicity, this work reinforces the need for effective and persistent communication to combat vaccine hesitancy. In describing parents' perceptions toward COVID-19 vaccination in their 5- to 11-year-old children, we contextualize vaccine hesitancy and highlight opportunities for existing evidence-based communication strategies to increase vaccine confidence and uptake in pediatric populations.

Exploration of the impact of political ideology disparity on COVID-19 transmission in the United States

BACKGROUND

Based on individual-level studies, previous literature suggested that conservatives and liberals in the United States had different perceptions and behaviors when facing the COVID-19 threat. From a state-level perspective, this study further explored the impact of personal political ideology disparity on COVID-19 transmission before and after the emergence of Omicron.

METHODS

A new index was established, which depended on the daily cumulative number of confirmed cases in each state and the corresponding population size. Then, by using the 2020 United States presidential election results, the values of the built index were further divided into two groups concerning the political party affiliation of the winner in each state. In addition, each group was further separated into two parts, corresponding to the time before and after Omicron predominated. Three methods, i.e., functional principal component analysis, functional analysis of variance, and function-on-scalar linear regression, were implemented to statistically analyze and quantify the impact.

RESULTS

Findings reveal that the disparity of personal political ideology has caused a significant discrepancy in the COVID-19 crisis in the United States. Specifically, the findings show that at the very early stage before the emergence of Omicron, Democratic-leaning states suffered from a much greater severity of the COVID-19 threat but, after July 2020, the severity of COVID-19 transmission in Republican-leaning states was much higher than that in Democratic-leaning states. Situations were reversed when the Omicron predominated. Most of the time, states with Democrat preferences were more vulnerable to the threat of COVID-19 than those with Republican preferences, even though the differences decreased over time.

CONCLUSIONS

The individual-level disparity of political ideology has impacted the nationwide COVID-19 transmission and such findings are meaningful for the government and policymakers when taking action against the COVID-19 crisis in the United States.

Attitudes toward COVID-19 vaccination of pregnant and lactating women in Hungary

OBJECTIVES

This study has three purposes. First, we explore the percentage of the population that is vaccinated and the factors that contribute to whether or not an individual takes up COVID-19 vaccination. Second, we also look at how pregnant and lactating women (PLW) take up vaccination. Third, we reveal what the public think about PLW receiving vaccines.

METHODS

Questionnaire data collection was carried out online using the quota method among Hungarians aged 18-65 with Internet access. The survey was carried out between 29th November and 11th December 2021. A total of 1,000 participants completed the questionnaire.

RESULTS

A total of 66.4% of the respondents aged 18-65 received vaccination. There were significant differences across sociodemographic variables in vaccination: men and individuals with more education, better perceived financial status, and personal experience with COVID-19 were more likely to be vaccinated. PLW were less likely to be vaccinated, partly due to their fear of vaccines' side-effects. More than one third of the participants do not agree with PLW having COVID-19 vaccination. In general, attitudes toward vaccination of PLW differed significantly by social group. Men and individuals with tertiary education and better financial situation, who knew somebody who had died of COVID-19 infection, and who had been vaccinated were more likely to accept vaccination for both pregnant women and lactating mothers.

CONCLUSIONS

Acceptance of receiving COVID-19 vaccination depends on social status; thus, targeted campaigns are required. In addition, PLW are afraid of vaccines' side effects, so they should be provided information, just as there is a need to increase public information on this topic.

COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach

BACKGROUND

Only 63.8% of Americans who are 18-to-24-years-old have been fully vaccinated for COVID-19 as of June 1, 2022. The Grand Forks County, North Dakota is facing a similar challenge. As of June 2022, 47% of individuals in the 19-to-29-year-old age group are vaccinated. Focusing on unvaccinated individuals in their 20s, Study 1 aims to understand the ways in which receiving COVID-19 vaccines is construed using qualitative interviews; and Study 2 compares the predictors of short-term vaccination intention (i.e., next month) with those of long-term vaccination intention (i.e., three to 5 years) using an online survey.

METHODS

For Study 1, we conducted five focus groups and four in-depth interviews via Zoom with a total of 26 unvaccinated individuals in their 20s living in the Grand Forks County. Constant comparison process was used to categorize data into themes and to recognize characteristics of the identified themes. The aim was to develop themes and associated characteristics. For Study 2, we conducted an online survey with a convenience sample of 526 unvaccinated individuals. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between attitudes, perceptions, and beliefs in misinformation and short-term and long-term vaccination intentions, accounting for demographics and socioeconomic status.

RESULTS

In Study 1, two themes were identified: feelings of uncertainty sparked by profits and monetization and navigating the fear of the unknown. In Study 2, an increase in the confidence of COVID-19 vaccines showed significantly higher odds of short-term intention (OR = 2.658, 95%CI 1.770, 3.990) and long-term intention (OR = 1.568, 95% CI 1.105, 2.226). Believing in misinformation had significantly lower odds of short-term intention (OR = 0.712, 95%CI 0.513, 0.990), while more positive attitudes (OR = 1.439, 95% CI 1.024, 2.024), stronger preference in calculating the benefits of COVID-19 vaccines (OR = 2.108, 95% CI 1.541, 2.882), and greater perceived susceptibility (OR = 1.471, 95% CI 1.045, 2.070) to and severity of contracting COVID-19 (OR = 1.362, 95% CI 1.020, 1.820) were significantly associated with higher odds of long-term intention.

CONCLUSIONS

Short-term and long-term intentions were predicted differently. Instilling strong confidence in COVID-19 vaccines should increase both short-term and long-term intentions.

The Long-COVID Experience Changed People's Vaccine Hesitancy but Not Their Vaccination Fear

Starting in early 2020, the COVID-19 pandemic has been responsible, worldwide, for millions of deaths and patients with long-COVID syndrome. In an attempt to stop the spread of the virus, the blanket administration of COVID-19 vaccines proved to be the most effective measure, yet the existence and availability of functional vaccines did not and, still, do not ensure the willingness and intent of people to be vaccinated. This study assessed the similarities and differences in vaccine fears and vaccine hesitancy through between clusters of subjects: people that were not infected with COVID-19, people that had COVID but did not develop long-lasting symptoms, and people that were infected with COVID and developed long-COVID syndrome. From the sample of 1111 Italian people, it was found that individuals who experienced mild symptoms showed higher vaccine hesitancy (confidence, complacency, and collective responsibility) than those who did not contract COVID-19. People affected by long-COVID showed a lower overall hesitancy than individuals who had COVID-19 without incurring long-lasting symptoms and, thus, essentially resembled people who had no experience of COVID-19 infection in terms of the vaccine hesitancy scores. Vaccine fear remained unchanged across all three of the examined clusters.

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusion

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

A Scoping Review of Three Dimensions for Long-Term COVID-19 Vaccination Models: Hybrid Immunity, Individual Drivers of Vaccinal Choice, and Human Errors

The virus that causes COVID-19 changes over time, occasionally leading to Variants of Interest (VOIs) and Variants of Concern (VOCs) that can behave differently with respect to detection kits, treatments, or vaccines. For instance, two vaccination doses were 61% effective against the BA.1 predominant variant, but only 24% effective when BA.2 became predominant. While doses still confer protection against severe disease outcomes, the BA.5 variant demonstrates the possibility that individuals who have received a few doses built for previous variants can still be infected with newer variants. As previous vaccines become less effective, new ones will be released to target specific variants and the whole process of vaccinating the population will restart. While previous models have detailed logistical aspects and disease progression, there are three additional key elements to model COVID-19 vaccination coverage in the long term. First, the willingness of the population to participate in regular vaccination campaigns is essential for long-term effective COVID-19 vaccination coverage. Previous research has shown that several categories of variables drive vaccination status: sociodemographic, health-related, psychological, and information-related constructs. However, the inclusion of these categories in future models raises questions about the identification of specific factors (e.g., which sociodemographic aspects?) and their operationalization (e.g., how to initialize agents with a plausible combination of factors?). While previous models separately accounted for natural- and vaccine-induced immunity, the reality is that a significant fraction of individuals will be both vaccinated and infected over the coming years. Modeling the decay in immunity with respect to new VOCs will thus need to account for hybrid immunity. Finally, models rarely assume that individuals make mistakes, even though this over-reliance on perfectly rational individuals can miss essential dynamics. Using the U.S. as a guiding example, our scoping review summarizes these aspects (vaccinal choice, immunity, and errors) through ten recommendations to support the modeling community in developing long-term COVID-19 vaccination models.

Cross-National Vaccine Concerns and Predictors of Vaccine Hesitancy in Not-Fully Vaccinated Individuals: Findings from USA, Canada, Sweden, and Italy

Vaccine hesitancy is a key contributor to reduced COVID-19 vaccine uptake and remains a threat to COVID-19 mitigation strategies as many countries are rolling out the campaign for booster shots. The goal of our study is to identify and compare the top vaccine concerns in four countries: Canada, Italy, Sweden, and the USA and how these concerns relate to vaccine hesitancy. While most individuals in these countries are now vaccinated, we expect our results to be helpful in guiding vaccination efforts for additional doses, and more in general for other vaccines in the future. We sought to empirically test whether vaccine related concerns followed similar thematic issues in the four countries included in this study, and then to see how these themes related to vaccine hesitancy using data from a cross-sectional survey conducted in May 2021. We applied CFA and created vaccine concern scales for analysis. We then utilized these results in regression-based modeling to determine how concerns related to vaccine hesitancy and whether there were similar or different concerns by country. The results quantitatively highlight that the same vaccine related concerns permeated multiple countries at the same point in time. This implies that COVID-19 vaccination communications could benefit from global collaboration.

Why do people consent to receiving SARS-CoV-2 vaccinations? A representative survey in Germany

OBJECTIVE

To answer the question: Why do people consent to being vaccinated with novel vaccines against SARS-CoV-2?

DESIGN

Representative survey.

SETTING

Online panel.

PARTICIPANTS

1032 respondents of the general German population.

METHOD

A representative survey among German citizens in November/December 2021 that resulted in 1032 complete responses on vaccination status, sociodemographic parameters and opinions about the COVID-19 situation.

RESULTS

Almost 83% of the respondents were vaccinated. The major motivation was fear of medical consequences of an infection and the wish to lead a normal life again. The major motivation to be not vaccinated was the fear of side effects and scepticism about long-term effectiveness and safety. Sixteen per cent of vaccinated respondents reported some serious side effect, while more than 30% reported health improvements, mostly due to the relief of psychological stress and social reintegration. We also validated a 'Corona Orthodoxy Score-COS' consisting of seven items reflecting opinions on COVID-19. The scale is reliable (alpha=0.76) and unidimensional. The COS was a highly significant predictor of vaccination status and readiness to be vaccinated in a multivariable logistic regression model. Those who were vaccinated were more likely to live in smaller households (OR=0.82, p=0.024), had a higher income (OR=1.27, p<0.001), a higher COS score (OR 1.4, p<0.0001) and used less alternative media (OR=0.44, p=0.0024) and scientific publications (OR=0.42, p=0.011) as information sources.

CONCLUSIONS

The major motives for being vaccinated are fear of medical symptoms and the wish to lead a normal life. Those not wanting to be vaccinated cite a lack of knowledge regarding long-term safety and side effects as reasons. This can likely only be overcome by careful and active long-term efficacy and safety monitoring.

Trust in God and/or Science? Sociodemographic Differences in the Effects of Beliefs in an Engaged God and Mistrust of the COVID-19 Vaccine

At present, COVID-19 vaccines are widely available in the USA, but large proportions of the American populace remain unvaccinated. One possible source of COVID-19 vaccine hesitancy is a lack of trust in science. In this study, drawing from the large literature at the intersection of science and religion, we ask whether beliefs in an engaged God (the belief that God is involved in daily human affairs) predict mistrust of the COVID-19 vaccine and whether any observed association differs across race, gender, and education. Using nationally representative data from Wave 6 of the Baylor Religion Survey (2021), our results suggest that beliefs in an engaged God were associated with greater mistrust in the COVID-19 vaccine. This association was amplified for Hispanic and lower educated Americans. We argue that beliefs in an engaged God may promote a distrust of science, reduce motivation to get vaccinated, and derive comfort and strength by placing control over one's life in the hands of a loving, involved deity. We also situate our findings within an emerging body of work on the "dark side" of religion and reflect on their implications for understanding the broader religion/health connection.