The public's attitude to and acceptance of periodic doses of the COVID-19 vaccine: A survey from Jordan

The continuance intention to vaccinate against COVID-19: An empirical study from Malaysia

BACKGROUND

Vaccination has been one of the most effective preventive strategies to contain the COVID-19 pandemic. However, as the COVID-19 vaccines' effect wanes off after some time and given their reduced level of protection against mutation strains of the virus, the calls for boosters and second boosters signal the need for continuous vaccination for the foreseeable future. As Malaysia transitions into the endemic phase, the nation's ability to co-exist with the virus in the endemic phase will hinge on people's continuance intention to be vaccinated against the virus. Adapting the expectations confirmation model (ECM) to the public health context and in a developing country, this study integrates the ECM with the health belief model (HBM) and the theory of reasoned action (TRA) to examine the inter-relationships of the predictors of people's continuance intention to vaccinate against COVID-19.

METHODOLOGY

Data were collected using self-administered questionnaires from 1,914 respondents aged 18 and above by a marketing consulting firm via its online panel. The partial least squares structural equation modeling (PLS-SEM) technique was used to analyze the data.

RESULTS

Out of the 1,914 respondents, 55.9% reported having a continuance intention to vaccinate against COVID-19, similar to other developing countries. The multivariate analysis revealed that perceived usefulness and satisfaction significantly influenced individuals' continuance intention to vaccinate against COVID-19. Additionally, attitude was found to play a key role in influencing behavioral change among individuals towards their perceptions of continuously getting vaccinated against COVID-19.

CONCLUSIONS

By integrating three theoretical frameworks (i.e., HBM, TRA and ECM), this study showed that behavioral characteristics could provide insights towards continuance vaccination intention. Hence, policymakers and key stakeholders can develop effective public health strategies or interventions to encourage vaccine booster uptake by targeting behavioral factors such as perceived usefulness, attitude, satisfaction, and subjective norms.

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.

Are People Willing to Take Regular COVID-19 Vaccines? Prevalence and Determinants of Hesitancy for Regular COVID-19 Vaccination: A Random Population-Based Survey in Hong Kong

The emergence of new coronavirus variants and evidence of waning immunity offered by COVID-19 vaccines draw attention to the need for regular vaccination. Vaccine hesitancy is one of the top ten threats to global health. There is a dearth of knowledge on people's hesitancy to take regular COVID-19 vaccines. This study aimed to investigate the prevalence and determinants of hesitancy for regular COVID-19 vaccination. A population-based, random telephone survey was performed in Hong Kong in April 2022 (n = 1213). The age-standardized hesitancy rate for regular COVID-19 vaccines among Hong Kong adults was 39.4% (95% CI = 35.3-44.1%), exhibiting a sloping S-shape with age. Regression analyses revealed that females, young adults, self-perceived fair/bad health, low COVID-19 vaccine uptake, and believing there are better ways for prevention of infection were positive determinants of hesitancy for regular vaccination. Vaccine confidence, perceived severity and availability, trust in manufacturers and government, and civic duty inclination were negative determinants. Tailored vaccine promotions are needed for females, young adults, and people perceiving poor health and receiving fewer doses. Information on infection severity, vaccine availability, and trust in suppliers, products, and governments are key attitude-change facilitators to decrease hesitancy for regular COVID-19 vaccination and cope with future pandemics.

Factors Affecting the Public Intention to Repeat the COVID-19 Vaccination: Implications for Vaccine Communication

Although most of the pandemic-related mandatory restrictions have been lifted or eased, vaccination is still recommended as an effective measure to minimize the damage from COVID-19 infection. Since COVID-19 eradication is unlikely, it is necessary to understand the factors affecting the public's vaccination intention when COVID-19 vaccination is continuously recommended. This study aims to explore the factors that affect the intention to repeat the COVID-19 vaccination in South Korea. An online survey was conducted in January 2022 with adults living in Gyeonggi-do, South Korea. In a hierarchical logistic regression analysis, sociodemographic factors, COVID-19 infection-related factors, COVID-19 vaccination-related factors, sociocultural factors, and communication factors were taken into account. In this study, more than three-quarters (78.1%) of Koreans were willing to repeat the COVID-19 vaccination. People who had high-risk perceptions, had been vaccinated against COVID-19 at least once, had more authoritarian attitudes, regarded the vaccination as a social responsibility, and had positive attitudes toward health authorities' regular briefings were more likely to repeat the vaccination. In contrast, those who directly or indirectly experienced COVID-19 vaccine side effects and who showed psychological reactance against the government's vaccination recommendation were less likely to repeat the vaccination. Our research indicates that empathetic communication, promotion of the prosocial aspect of vaccination, and regular and transparent provision of vaccine information are essential for promoting the intention to repeat the COVID-19 vaccination.

Willingness of Healthcare Workers to Recommend or Receive a Third COVID-19 Vaccine Dose: A Cross-Sectional Study from Jordan

Background: The availability of COVID-19 vaccines worldwide necessitates measuring healthcare workers’ (HCWs’) willingness to recommend or receive these vaccines. Therefore, we conducted a local study in Jordan to assess HCWs’ willingness to recommend or receive a third dose of a COVID-19 vaccine and the predictors of such a decision. A cross-sectional study investigated Jordanian HCWs’ willingness regarding a third dose of a COVID-19 vaccine using a self-administered online questionnaire through WhatsApp, a mobile phone application. A total of 300 HCWs participated in the current study. Of these HCWs, 65.3% were physicians, 25.3% were nurses, and 9.3% were pharmacists. HCWs’ overall willingness regarding a third vaccine dose was 68.4% (49.4% certainly and 19.0% probably), whereas the overall willingness of HCWs to recommend a third dose to their patients was 73.3% (49.0% certainly and 24.3% probably). Males had significantly higher willingness than females (82.1% vs. 60.1%, p < 0.05). Physicians reported more willingness than nurses and pharmacists. HCWs’ willingness was not significantly affected by direct contact with a patient infected with COVID-19 or by a personal history of COVID-19 infection. Only 31% of HCWs were certainly willing to recommend the vaccine to their patients with chronic diseases, and only 28% of the participants were certainly willing to recommend it to people aged 65 or older. HCWs’ willingness to receive a third dose of a COVID-19 vaccine is limited in Jordan. This has affected their certainty in recommending this vaccine to their patients or people older than 60. Decision-makers and health-promotion programs in Jordan should focus on addressing this public health problem.

Drivers of and Barriers to COVID-19 Vaccine Booster Dose Acceptance in Indonesia

Obtaining a booster dose of coronavirus disease 2019 (COVID-19) vaccine is required to maintain the protective level of neutralizing antibodies and therefore herd immunity in the community, and the success of booster dose programs depends on public acceptance. The aim of this study was to determine the acceptance of a booster dose of COVID-19 vaccine and its drivers and barriers in Indonesia. A cross-sectional survey was conducted in the provinces of Indonesia between 1 and 15 August 2022. Individuals who completed the primary series of the COVID-19 vaccine were asked about their acceptance of a booster dose. Those who refused the booster dose were questioned about their reasons. A logistic regression was used to determine the determinants associated with rejection of a booster dose of COVID-19 vaccine. A total of 2935 respondents were included in the final analysis. With no information on the efficacy and safety of the COVID-19 vaccine, 95% of respondents agreed to receive a booster dose if it were provided for free by the government. This acceptance was reduced to only 50.3% if the vaccine had a 75% efficacy with a 20% chance of side effects. The adjusted logistic regression analysis indicated that there were eight factors associated with the rejection of the booster dose: age, marital status, religion, occupation, type of the first two vaccines received, knowledge regarding the importance of the booster dose, belief that natural immunity is sufficient to prevent COVID-19 and disbelief in the effectiveness of the booster dose. In conclusion, the hesitancy toward booster doses in Indonesia is influenced by some intrinsic factors such as lack of knowledge on the benefits of the booster dose, worries regarding the unexpected side effects and concerns about the halal status of the provided vaccines and extrinsic determinants such as the effectiveness and safety of the vaccine. These findings suggest the need for more campaigns and promotions regarding the booster dose benefits to increase its acceptance.

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.