The Willingness to Receive COVID-19 Vaccine and Its Associated Factors: "Vaccination Refusal Could Prolong the War of This Pandemic" - A Systematic Review

The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

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

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

Lessons for Future Vaccination Policies: COVID-19 Vaccination Intention in People With and Without Chronic Diseases

PURPOSE

This study compared COVID-19 vaccination intentions in those with and without chronic diseases (CDs and non-CDs) in South Korea. We hypothesized that the factors associated with COVID-19 vaccination intentions would differ between CDs and non-CDs in South Korea.

METHODS

Using survey data collected through a Korean online panel in June 2021, we conducted a cross-sectional secondary data analysis. Of the 2292 participants, 411 had at least one chronic disease. To construct a comparable dataset, we selected non-CDs via a 1:1 case-control matching for age and gender. We then utilized a multivariable binary logistic regression model to explore the factors contributing to COVID-19 vaccination intentions in CDs and non-CDs.

RESULTS

All told, over 75% of participants in both groups indicated that they intended to vaccinate against COVID-19. In both groups, those who mistrusted general vaccine benefits reported significantly lower COVID-19 vaccination intentions. Regarding factors associated with vaccination intentions, CDs identified anxiety regarding coronavirus and exposure to COVID-19 vaccination promotions at the community level, while non-CDs highlighted hesitancy regarding vaccines and confidence in government/health services.

CONCLUSION

Improving vaccination acceptance will require the development and implementation of tailored approaches for CDs and non-CDs and efforts to minimize general vaccine mistrust.

Impacts of COVID-19 vaccine boosters on clinical outcomes associated with the Omicron variant in China: A cross-sectional survey

Objective

To investigate the real-world effectiveness of COVID-19 vaccine boosters during China's Omicron wave.

Methods

In January 2023, we surveyed Shenzhen, China residents via online questionnaires to investigate their COVID-19 symptoms and vaccination history. The outcomes of interest included fever, other COVID-19-related symptoms, severity of symptoms, whether early onset (before December 23, 2022) and duration. Respondents were categorized as no booster, one booster 6mo ago, one booster within 6mo, or two boosters based on dose count and vaccination timing. We used multivariable logistic regressions and Tobit models to assess COVID-19 vaccine booster impacts.

Results

Compared to the no booster group, two booster recipients had a lower fever risk (OR = 0.35, 95 %CI = 0.16-0.76) but not lower risks of COVID-19-related symptoms (OR = 0.74, 95 %CI = 0.26-2.06) and self-reported severe symptoms (OR = 0.47, 95 %CI = 0.19-1.15). Nor did the two booster recipients had a shorter illness duration (marginal effect = -0.79 days, 95 %CI = -1.65-0.07) and a lower risk of symptom onset delay (OR = 0.48, 95 %CI = 0.19-1.23). Compared to the no booster group, both one booster within six months (OR = 2.17, 95 %CI = 1.34-3.52) and one booster six months ago (OR = 1.30, 95 %CI = 0.92-1.82) did not reduce the risks of fever and symptoms (one booster within six months: OR = 1.57, 95 %CI = 0.84-2.90; one booster six months ago: OR = 1.23, 95 %CI = 0.79-1.93). Regardless of timing, one booster did not reduce illness duration (within six months: marginal effect = 0.25 days, 95 %CI = -0.20-0.70; six months ago: marginal effect = 0.27 days, 95 %CI = -0.08-0.62). However, receiving one booster within six months delayed symptom onset (OR = 0.54, 95 %CI = 0.34-0.86), while one booster six months ago did not (OR = 1.03, 95 %CI = 0.74-1.44).

Conclusions

Receiving two booster doses reduced the onset of fever during the Omicron outbreak in mainland China.

COVID-19 vaccine acceptance and associated determinants in Addis Ketema Sub-city, Addis Ababa, Ethiopia: A community-based study

Background

Despite the global surge in the Corona virus disease (COVID-19) pandemic, people's efforts to combat the pandemic have been insufficient. The world has experienced a number of challenges in terms of COVID-19 vaccine acceptance. Therefore, understanding the community's willingness to receive the vaccine will aid in the creation and implementation of effective COVID-19 immunization. As a result, the aim of this study was to assess the magnitude of COVID-19 vaccine acceptance and associated factors among adults in Addis Ababa, Ethiopia.

Methods

A community-based cross-sectional study with 419 household heads was undertaken in Addis Ababa, Ethiopia. To identify factors associated with the outcome and independent variables, bi-variable and multi-variable logistic regression analyses were used. A 95% confidence interval and a p-value of less than 0.05 were deemed sufficient to declare a significant association.

Results

The level of COVID-19 vaccine acceptance was 46.3 % (95 % CI: 43.87-48.73). Moreover, age groups above 58 years (AOR = 0.38, 95: CI: 0.17, 0.84), chronic disease (AOR: 2.09, 95 % CI: 1.28-3.42), a positive attitude (AOR: 1.64, 95 % CI: 1.29-2.04), being a Muslim (AOR: 0.36, 95 % CI: 0.19-0.71) and social support (AOR: 1.7, 95 % CI: 1.04-2.79) were all significantly related to COVID-19 vaccine acceptance.

Conclusion

The findings of this study revealed a lower rate of COVID-19 vaccination acceptance. Age, chronic disease, attitude, and social support were significant predictors of COVID-19 vaccine acceptance. Therefore, emphasis should be given for community mobilization, especially for the elderly, those with limited social engagement, and those who have a negative attitude toward COVID-19 vaccination.

Factors associated with willingness to receive coronavirus disease vaccination during the pandemic: A nationwide survey in Taiwan

BACKGROUND/PURPOSE

Vaccination is the most important preventive measure to protect people from coronavirus disease 2019 (COVID-19). Governments worldwide have prioritized their vaccination policy against COVID-19. However, there is a lack of relevant research on Taiwanese attitudes and considerations toward COVID-19 vaccination. This study aimed to investigate the cognition, preventive behaviors, and attitudes toward COVID-19 vaccines that influence people's willingness to get vaccinated in Taiwan.

METHODS

From October 1 to 31, 2021, a computer-assisted telephone interview system was used to randomly select Taiwanese people to investigate their COVID-19 preventive behaviors, knowledge, and willingness to be vaccinated.

RESULTS

We included 2000 participants of whom 96.45% showed vaccination willingness. The overall mean age and knowledge scores were 48.6 years and 5.78, respectively. All of the participants chose to wear masks, and 80% chose to be vaccinated to prevent COVID-19. Compared with the non-willing vaccination participants, those with younger ages, higher incomes, and higher knowledge scores regarding masks and vaccination were more likely to be vaccinated. Furthermore, apprehensions about vaccine side effects and negative news about COVID-19 vaccines were the major reasons for vaccination hesitancy.

CONCLUSION

To improve people's willingness to get vaccinated, the government should strive to deliver correct knowledge and refute inappropriate negative information about COVID-19 vaccination. Moreover, recommendation by physicians was an important factor for older individuals to decide on receiving the COVID-19 vaccine, and policies could be implemented from this aspect.

Impact of COVID-19 on the veteran population: evidence from the Trends in Scottish Veterans Health study

INTRODUCTION

There have been few epidemiological studies on the impact of the SARS-CoV-2 (COVID-19) pandemic on the veteran population, other than on specific aspects such as mental health, and none in the UK. We used data from the Trends in Scottish Veterans Health cohort to explore the risk of hospitalisation and death associated with COVID-19 in veterans resident in Scotland in comparison with matched non-veterans.

METHODS

Retrospective cohort study of 71 000 veterans and a comparison group of 230 000 non-veterans matched for age, sex and geography, using Cox proportional hazard analysis to explore the risk of hospitalisation with COVID-19 and COVID-19-associated death overall and by birth cohort, sex and length of military service.

RESULTS

Between 1 January 2020 and 31 December 2021, 564 (0.79%) veterans had been hospitalised with COVID-19 compared with 1728 (0.75%) non-veterans. The Cox model showed no significant difference overall, HR 0.99, 95% CIs 0.90 to 1.11, p=0.800. Subgroup analysis showed increased risk in older, short-serving (<20 weeks) Early Service Leavers (ESL). There was no overall difference in COVID-19-associated deaths, HR 0.99, 95% CI 0.79 to 1.23, p=0.993, but subgroup analysis showed a non-significant reduced risk of death in veterans aged 61-70 years, and a 38% higher risk in veterans aged over 70 years which almost reached statistical significance, p=0.054. This was only partially explained by socioeconomic factors and common comorbidities, although we had no data on domestic circumstances or care home residence.

CONCLUSIONS

Overall, military service was not a risk factor for either hospitalisation or death associated with COVID-19. Older ESLs were at increased risk compared with non-veterans, but military service is unlikely to have been causal. The risk of death was increased in the oldest veterans and further studies are needed to explain this once census data become available for linkage.

Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10-12 years of age-A step toward prevention of future COVID-19 outbreaks in India

Purpose

COVID-19 was declared a global pandemic and all age groups were equally affected. Coronavirus had devastating effects worldwide due to the emergence of new variants till vaccination was adopted to eradicate the transmission of the virus and restore normalcy. However, children were not included in the initial phase of vaccination. The purpose of the study was to assess the level of perception, attitude, and practice among parents toward the COVID-19 vaccination drive in children 10-12 years of age.

Design and Study

The present research is a cross-sectional questionnaire-based survey including parents of children aged 10-12 years as participants. The survey was conducted between May 2022 and July 2022 with a sample size of 320.

Results

A high willingness (80%) among parents was found for getting their children vaccinated. COVID-19 vaccines were perceived to be safe by the parents (59%) and efficacious (75%) for their children. Parents (67%) felt that the benefits of getting their children vaccinated against COVID-19 prevail over the risks of the vaccine. Parents 214 (67%) feel the need of getting their child vaccinated for sending them to school followed by availing of daycare facilities after school 54 (17%) among working parents. A significant association (P < 0.05) was seen between the variables of practice being followed by parents and their children as per COVID-19 norms. Parent's negative attitude toward COVID-19 vaccination was associated with availability of no/unclear safety information (36%), fear of adverse effects of vaccine (3%), and false belief of having long-term immunity due to natural infection (32%). The positive attitude of parents was due to trust in positive information/news about the vaccine (42%), belief in the safety and efficacy of the vaccine (5%), acceptability for mild adverse effects (1%), and the necessity of vaccine to send children to schools (1%).

Conclusion and Recommendations

The awareness of parents regarding COVID-19 vaccination for children was limited, high level of acceptance for vaccination was seen in our study. We recommend to continuing educational programs through mass campaigns to increase increasing awareness among parents for getting COVID-19 vaccination for their children. Vaccine hesitancy including vaccine safety concerns of parents should be addressed by presenting myths and facts related to COVID-19 vaccine using television, radio, and social media platforms.

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

Willingness to receive COVID-19 vaccines, associated factors and reasons for not taking a vaccine: a cross sectional study among persons aged 13-80 years in Wakiso, Central Uganda

BACKGROUND

Vaccination has been recommended as one of the approaches for the control of COVID-19 pandemic. However, adequate vaccine coverage is critical to the effectiveness of the vaccine at population level. Data on acceptability of the vaccine in Ugandan urban areas are limited. This study examined the prevalence, factors associated with willingness to accept COVID-19 vaccine including reasons for not taking COVID-19 vaccine in a predominantly urban population of Wakiso, central Uganda.

METHODS

Data were obtained from a cross-sectional study conducted between March 1st, 2021 and September 30th, 2021 in the urban population-based cohort of the Africa Medical and behavioral Sciences Organization (AMBSO). A Multivariable modified Poisson regression analysis was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals of willingness to accept the COVID-19 vaccine.

RESULTS

A total of 1,903 participants were enrolled in this study; 61% of whom were females. About 63% of participants indicated their willingness to accept the COVID-19 vaccine. Persons aged 13-19 years (aPR = 0.79; [95% CI: 0.74, 0.84]) or 20-29years (aPR = 0.93; [95% CI: 0.88, 0.98]) were less likely to accept the vaccine compared to persons aged 40-49 years. Persons with post-primary level of education (aPR = 1.05; [95% CI: 1.02, 1.09]) were more likely to accept the vaccine compared to persons with primary level of education. Additionally, students or individuals working in government (aPR = 1.13; [95% CI: 1.04, 1.23]) were more likely to accept the vaccine compared to individuals doing construction and Mechanic work as their main occupation. Reported reasons for not taking a COVID-19 vaccine included; concerns about side effects of the vaccine 154(57.0%), 64(23.7%) did not think the vaccines were effective, while 32(11.9%) did not like the vaccines.

CONCLUSION

A substantial proportion of individuals were not willing to accept the COVID-19 vaccine. Health education campaigns on vaccination within urban communities could help reduce COVID-19 vaccine misconceptions in the urban populations more especially the young and persons with low levels of formal education.

Views of Nigerian civil servants about compulsory COVID-19 vaccination: A qualitative study

BACKGROUND

 COVID-19 caused unforeseen global burden, although vaccine strategy rapidly stalled transmission and protected those at risk. Many governments made vaccination mandatory for public space access.

AIM

 This study aimed to elucidate perception of Nigerian civil servants towards mandatory COVID-19 vaccination and elicited their recommendations.

SETTING

 This study was conducted in twelve purposively selected states in the six geopolitical zones and the Federal Capital Territory (FCT), Nigeria. Relevant ministries, departments and agencies were selected within the study sites.

METHODS

 It was a qualitative study that interviewed consenting civil servants. Ethical approval was obtained from the National Health Research Ethics Committee. Interviews were conducted in person, following a pre-test. Data was analysed using NVivo software version 12.

RESULTS

 Most participants were willing to take the vaccine if their safety was assured. However, enforcement to do so was a hindrance. Most participants commended the government for the effort to curb COVID-19 transmission and create awareness but were displeased with planning and handling of misconceptions. They recommended a more committed approach to vaccine production and funding by the government.

CONCLUSION

 Participants were willing to take the COVID-19 vaccines because the gains of protection outweighed the risks. They suggested a less involuntary approach through reinforcing awareness creation and avoiding threats.Contribution: There is limited qualitative research on perception of Nigerian civil servants regarding mandatory COVID-19 vaccination. Being the main driving force of Nigeria's public service, their views are invaluable. Findings could contribute to future policies in times of emergency.

Global COVID-19 vaccine acceptance level and its determinants: an umbrella review

BACKGROUND

The COVID-19 vaccination is essential for reducing disease burden on a worldwide scale. The success of this strategy will largely depend on how well vaccines are received. Previous reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the COVID-19 vaccination's global acceptance rate and its contributing factors.

METHODS

Using PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported COVID-19 vaccine acceptance and/or its determinants were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed.

RESULT

Twenty-two SRM with 10,433,306 study participants were included. The pooled COVID-19 vaccine acceptance rate globally is found to be 60.23 (95% CI: 58.27, 62.18). In low-income countries, the pooled level of COVID-19 vaccine acceptance was found to be 54.07(50.31, 57.83) while this magnitude is 64.32 (62.24,66.40) among studies across the globe. Higher level of education (AOR =1.96; 95% CI:1.20, 2.73), good level of knowledge (2.20; 95% CI:1.36, 3.03), favourable attitude (AOR =4.50; 95% CI:2.89, 6.12), previous history of COVID-19 infection (AOR =3.41; 95% CI:1.77, 5.06), male sex (AOR =1.62; 95% CI:1.47, 1.77), and chronic disease (AOR =1.54; 95% CI:1.18, 1.90) were predictors of COVID-19 vaccine acceptance.

CONCLUSION

The pooled level of COVID-19 vaccine acceptance highly varied and found to be unacceptably low particularly in low-income countries. Higher level of education, good level of knowledge, favourable attitude, previous history of COVID-19, male sex, and chronic disease were factors of COVID-19 vaccine acceptance rate. A collaborative effort of stakeholders such as policymakers, and vaccine campaign program planners is needed to improve the acceptance rate of COVID-19 vaccine.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Encouraging COVID-19 vaccination by focusing on anticipated affect: A scoping review

OBJECTIVE

This study reviewed studies of the anticipated affect related with COVID-19 vaccination to understand gaps in currently available studies and practice implications.

METHODS

We systematically searched MEDLINE, CINAHL, and other multiple databases for English language articles of studies that investigated COVID-19 vaccination related anticipated affects.

RESULTS

We identified seventeen studies. Thirteen studies focused anticipated regret from inaction (i.e., not vaccinated). Other studies focused anticipated regret from action (i.e., vaccinated), guilt from inaction, pride from action, and positive feelings from action. Eleven studies showed that anticipated regret from inaction was significantly associated with COVID-19 vaccination behavior or intention. Three of the 11 studies showed that anticipated regret from inaction was more strongly associated with vaccination behavior or intention than cognitive belief.

CONCLUSION

Most studies showed that positive associations between anticipated regret and COVID-19 vaccination outcomes. The use of messages that target cognitive beliefs as well as those that appeal to anticipated affect may be effective to promote COVID-19 vaccination. However, most studies employed a cross-sectional design and examined negative affect. Future studies should adopt an experimental design as well as examine positive affect.

Advances in Cancer Vaccine Research

The use of cancer vaccines is considered a promising therapeutic strategy in clinical oncology, which is achieved by stimulating antitumor immunity with tumor antigens delivered in the form of cells, peptides, viruses, and nucleic acids. The ideal cancer vaccine has many advantages, including low toxicity, specificity, and induction of persistent immune memory to overcome tumor heterogeneity and reverse the immunosuppressive microenvironment. Many therapeutic vaccines have entered clinical trials for a variety of cancers, including melanoma, breast cancer, lung cancer, and others. However, many challenges, including single antigen targeting, weak immunogenicity, off-target effects, and impaired immune response, have hindered their broad clinical translation. In this review, we introduce the principle of action, components (including antigens and adjuvants), and classification (according to applicable objects and preparation methods) of cancer vaccines, summarize the delivery methods of cancer vaccines, and review the clinical and theoretical research progress of cancer vaccines. We also present new insights into cancer vaccine technologies, platforms, and applications as well as an understanding of potential next-generation preventive and therapeutic vaccine technologies, providing a broader perspective for future vaccine design.

Understanding Attitudes Toward Influenza Vaccination: Insights from a Romanian Family Medicine Patient Population

INTRODUCTION

Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial mortality rates. Vaccine hesitancy, characterized by delays or refusals despite vaccine availability, presents a growing challenge in achieving adequate vaccination rates globally.

AIM

This study aimed to assess the attitudes of Romanian general practitioners' patients toward influenza vaccination during the recommended immunization period.

MATERIALS AND METHODS

A prospective multi-centered study involving 319 patients across five Family Medicine Offices in Romania was conducted. Participants completed a 12-item Vaccination Attitudes Examination (VAX) scale, assessing factors influencing vaccine acceptance. Statistical analyses were performed to evaluate the impact of demographic variables and attitudes toward vaccination.

RESULTS

The study revealed significant variations in attitudes influencing influenza vaccine acceptance. Trust in vaccine benefits and confidence in natural immunity emerged as primary motivators for vaccine acceptance/denial, whereas concerns about commercial profiteering held lesser importance. Gender and residential environment impacted specific attitudes toward vaccination, while factors such as education and employment status did not significantly influence vaccine acceptance.

DISCUSSION

The study underscores the critical role of trust in vaccine benefits as a primary driver for vaccine acceptance, diverging from prevalent conspiracy theories. While gender and residential environment influenced attitudes toward vaccination, education and employment status did not exhibit significant correlations with vaccine acceptance.

CONCLUSIONS

Understanding public attitudes toward vaccination is crucial in designing effective public health strategies. This study emphasizes the importance of trust in vaccine benefits in driving vaccine acceptance, offering insights to enhance vaccination initiatives regionally.

COVID-19 Immunization Rates in Patients with Inflammatory Bowel Disease Worldwide: A Systematic Review and Meta-Analysis

Individuals with Inflammatory Bowel Disease (IBD) are characterized by an increased vulnerability to complications stemming from infectious diseases. While these patients do not inherently face a heightened risk of SARS-CoV-2 infection compared to the general population, their vulnerability to severe COVID-19 complications and subsequent hospitalization is notably increased. The objective of our study is to quantitatively assess the global coverage of COVID-19 vaccination among individuals with IBD, achieved through a comprehensive meta-analysis and systematic review. Thirteen studies were systematically selected from scientific articles available in the MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases, spanning from 1 January 2021 to 25 July 2023. The pooled prevalence of COVID-19 vaccine uptake was estimated at 72% (95%CI = 59-83%) for at least one dose, 81% (95%CI = 68-91%) for the complete vaccination regimen, and 71% (95%CI = 46-91%) for the third dose. Analysis of the determinants influencing vaccination uptake revealed several significant associations. These encompassed Caucasian ethnicity, female sex, absence of immunosuppressive therapy, advanced age, prior receipt of the anti-influenza vaccine, absence of a history of COVID-19 infection, and the provision of advice from gastroenterologists, all linked to improved compliance. Our study underscores a noteworthy yet not entirely optimal COVID-19 vaccination coverage among individuals with IBD. A multifaceted approach is warranted to enhance vaccination rates. Within this context, the role of gastroenterologists extends beyond direct patient care, encompassing a pivotal responsibility in preventing complications stemming from post-infectious diseases.

Role of Trust, Risk Perception, and Perceived Benefit in COVID-19 Vaccination Intention of the Public

COVID-19 vaccination is an effective method for dealing with the COVID-19 pandemic. This study proposed and validated a theoretical intention model for explaining the COVID-19 vaccination intention (CVI) of the public. The theoretical intention model incorporated trust in vaccines, two types of risk perception (risk perception of COVID-19 and risk perception of COVID-19 vaccination), and perceived benefit into a theory of planned behavior (TPB). Structural equation modeling was utilized to test the theoretical intention model with data collected from 816 Chinese adults in China. The results confirmed the crucial role of trust in vaccines, risk perception, and perceived benefit in shaping the CVI of the public. In addition, TPB was found to be applicable in a research context. The theoretical intention model accounted for 78.8% of the variance in CVI. Based on the findings, several practical recommendations for improving COVID-19 vaccination rates were discussed.

COVID-19 vaccination in pregnancy: the impact of multimorbidity and smoking status on vaccine hesitancy, a cohort study of 25,111 women in Wales, UK

BACKGROUND

Multimorbidity, smoking status, and pregnancy are identified as three risk factors associated with more severe outcomes following a SARS-CoV-2 infection, thus vaccination uptake is crucial for pregnant women living with multimorbidity and a history of smoking. This study aimed to examine the impact of multimorbidity, smoking status, and demographics (age, ethnic group, area of deprivation) on vaccine hesitancy among pregnant women in Wales using electronic health records (EHR) linkage.

METHODS

This cohort study utilised routinely collected, individual-level, anonymised population-scale linked data within the Secure Anonymised Information Linkage (SAIL) Databank. Pregnant women were identified from 13th April 2021 to 31st December 2021. Survival analysis was employed to examine and compare the length of time to vaccination uptake in pregnancy by considering multimorbidity, smoking status, as well as depression, diabetes, asthma, and cardiovascular conditions independently. The study also assessed the variation in uptake by multimorbidity, smoking status, and demographics, both jointly and separately for the independent conditions, using hazard ratios (HR) derived from the Cox regression model.

RESULTS

Within the population cohort, 8,203 (32.7%) received at least one dose of the COVID-19 vaccine during pregnancy, with 8,572 (34.1%) remaining unvaccinated throughout the follow-up period, and 8,336 (33.2%) receiving the vaccine postpartum. Women aged 30 years or older were more likely to have the vaccine in pregnancy. Those who had depression were slightly but significantly more likely to have the vaccine compared to those without depression (HR = 1.08, 95% CI 1.03 to 1.14, p = 0.002). Women living with multimorbidity were 1.12 times more likely to have the vaccine compared to those living without multimorbidity (HR = 1.12, 95% CI 1.04 to 1.19, p = 0.001). Vaccine uptakes were significantly lower among both current smokers and former smokers compared to never smokers (HR = 0.87, 95% CI 0.81 to 0.94, p < 0.001 and HR = 0.92, 95% CI 0.85 to 0.98, p = 0.015 respectively). Uptake was also lower among those living in the most deprived areas compared to those living in the most affluent areas (HR = 0.89, 95% CI 0.83 to 0.96, p = 0.002).

CONCLUSION

Younger women, living without multimorbidity, current and former smokers, and those living in the more deprived areas are less likely to have the vaccine, thus, a targeted approach to vaccinations may be required for these groups. Pregnant individuals living with multimorbidity exhibit a slight but statistically significant reduction in vaccine hesitancy towards COVID-19 during pregnancy.

Barriers and Intention to Get Vaccinated for COVID-19 and Associated Factors Among Adults in Southwest Ethiopia: A Theory of Planned Behavior Approach

Background

Different vaccines have been approved for use against coronavirus disease and distributed globally in different regions. Efforts should be made on the vaccination to control the spread and impacts of the coronavirus pandemic. However, the general population's attitudes and intention to uptake coronavirus disease 2019 (COVID-19) vaccinations were poor.

Objective

This study aimed to assess the barriers to and intention to be vaccinated against COVID-19 and the associated factors among adults in the Jimma zone, Ethiopia.

Methods

A community-based cross-sectional study with multistage sampling was conducted with 621 participants from 16 April to 17 May 2022. Multivariable logistic regression was used to identify factors associated with the outcome of interest. Statistical p-value ≤0.05 was set at p ≤ 0.05. Qualitative data were supplemented with quantitative results.

Results

The majority of the study participants (382 [61.5%]) intended to uptake the COVID-19 vaccine. In this study, travel history (Adjusted Odds Ratio (AOR) = 2.18, 95% CI 1.23-3.87), vaccination history (AOR = 2.64, 95% CI 1.69-4.12), perceptions of infection prevention for COVID-19 (AOR = 1.97, 95% CI 1.28-3.03), subjective norm (AOR = 2.27, 95% CI 1.52-3.39), and perceived behavioral control (PBC) (AOR = 2.30, 95% CI 1.55-3.41) were significantly associated with the intention to be vaccinated against COVID-19.

Conclusion

More than half of the adult participants intended to be vaccinated against COVID-19. The study participant's traveling history, vaccination history, perception of infection prevention for COVID-19, subjective norms, and Perceived Behavioral Control were significantly associated with the intention to be vaccinated.

Impact of Political Leaning on COVID-19 Vaccine Hesitancy: A Network-Based Multiple Mediation Analysis

Prior studies have shown that political affiliation affected COVID-19 vaccine hesitancy. This study re-examined the data to see if these findings hold after controlling for alternative explanations. The dependent variable in the study was COVID-19 vaccination rates in 3,109 counties in the United States as of April 2022. The study examined 36 possible alternative explanations for vaccine hesitancy, including demographic, social, economic, environmental, and medical variables known to affect vaccine hesitancy. County-level political affiliation was measured as a percent of voters in the county who were affiliated with Democratic or Republican political parties. Data were analyzed using a temporally constrained multiple mediation network, which allowed for the identification of both direct and indirect predictors of vaccination rates. Despite controlling for alternative explanations of hesitancy, there was a statistically significant relationship between the percentage of Republican supporters and rates of vaccine hesitancy. The higher the Republican affiliation, the lower the vaccination rates. It is possible that the Republican Party has played an organizing role in encouraging vaccine hesitancy and patient harm.

COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study

BACKGROUND

Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy.

OBJECTIVE

The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors.

METHODS

A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy.

RESULTS

Among the 1422 participants, 538 (37.8%) were not vaccinated against COVID-19. The COVID-19-recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95% CI 1.09-1.19). "Self-needs" was the main reason for patients to receive the COVID-19 vaccine, whereas "already have antibodies and do not need vaccination" was the main reason for patients to not receive the COVID-19 vaccine.

CONCLUSIONS

Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19-recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19-recovered patients could foster trust and promote their uptake of vaccination.

Measuring the importance of influencing factor for COVID-19 vaccination intention in China

Background

Vaccination is considered an effective approach to deter the spread of coronavirus disease (COVID-19). However, vaccine hesitancy is a common issue that makes immunization programs more challenging. To promote vaccination in a targeted and efficient way, this study aims to develop and validate a measurement tool for evaluating the importance of influencing factors related to COVID-19 vaccination intention in China, and to examine the demographic differences.

Methods

In study 1, we developed a Factor Importance Evaluation Questionnaire (FIEQ) based on semi-structured interview results and used exploratory factor analysis (EFA) to explore its factor structure. In study 2, we verified the four-factor structure of FIEQ by confirmatory factor analysis (CFA). We then administered FIEQ to Chinese participants and conducted a student t-test and analysis of variance to examine the differences in the importance evaluation of factors based on gender and educational level.

Results

In study 1, we developed a four-factor construct and retained 20 items after EFA (N = 577), with acceptable reliability (alpha = 0.87) and validity. In study 2, we found that the model fit was good (χ2 = 748.03 (162), p < 0.001, GFI = 0.949, RMSEA = 0.049, SRMR = 0.048, AGFI = 0.934), and reliability was acceptable (alpha = 0.730) (N = 1,496). No gender difference was found in factor importance. However, individuals with different educational levels reported significantly different importance evaluations of three factors, including perceived benefits and social norms (F = 3.786, p = 0.005), perceived influences from reference groups (F = 17.449, p < 0.001), and perceived risks (F = 2.508, p = 0.04).

Conclusion

This study developed and validated FIEQ for measuring the importance of influencing factors related to the COVID-19 vaccination intention in Chinese participants. Moreover, our findings suggest that the educational level may play a role in how individuals evaluate the importance of factors. This study provides insights into the concerns that individuals have regarding vaccination and offers potentially effective and targeted strategies for promoting COVID-19 vaccination.

The determinants of COVID-19 vaccination intention: a meta-review

Background

A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI.

Methods

This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias.

Results

Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being.

Conclusions

These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis

Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake.

How does the vaccine approval procedure affect COVID-19 vaccination intentions?

People's willingness to vaccinate is critical to combating the COVID-19 pandemic. We devise a representative experiment to study how the design of the vaccine approval procedure affects trust in newly developed vaccines and consequently public attitudes towards vaccination. Compared to an Emergency Use Authorization, choosing the more thorough Conditional Marketing Authorization approval procedure increases vaccination intentions by 13 percentage points. The effects of the increased duration of the approval procedure are positive and significant only for Emergency Use Authorization. Treatment effects do not differ between relevant subgroups, such as respondents who had (did not have) COVID-19, or between vaccinated and unvaccinated respondents. Increased trust in the vaccine is the key mediator of treatment effects on vaccination intentions.

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California

Objectives

To describe vaccine and booster uptake by neighborhood-level factors in California.

Methods

We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions.

Results

In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region.

Conclusions

Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.

COVID-19 Vaccine Acceptance, Attitude, Hesitancy, and Its Associated Factors among Wolaita Sodo University Students: A Mixed-Method Study

Background

Countries in the world have been experiencing the ongoing impact and spread of the coronavirus disease (COVID-19) virus pandemic. The health and financial burden of the pandemic has prompted the need for timely and effective vaccination to be considered as the best strategy for controlling disease transmission. However, vaccine acceptability remains an area of concern in developing countries like Ethiopia.

Objective

To assess attitude, hesitancy in the COVID-19 vaccine acceptance, and associated factors among health science students at Wolaita Sodo University.

Methods

A triangulated mixed-method study was conducted. Quantitative data were entered into SPSS Windows version 25 for analysis, and the qualitative data were transcribed using open code version 4.3. A binary logistic regression model was used to establish the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the strengths of the association. Thematic approach was used for qualitative data analysis.

Results

A total of 352 students participated in this study. Having family members who were infected with COVID-19, information about COVID-19 vaccine, the need for a vaccine with the level of concern, intention to take COVID-19 vaccine, and academic year were strongly associated with vaccine acceptability. Graduating class and other senior students were about 4 and 2 times more likely to accept vaccination as compared to freshman-year students (AOR = 4.128; 95% CI: 1.351-12.610;P = 0.012) and (AOR = 2.195; 95% CI: 1.182-4.077; P value = 0.013), respectively. Even if 67% of students had a good attitude towards the vaccine, 56% of the students hesitated to take the vaccine.

Conclusion

The majority of respondents had a constructive attitude towards the COVID-19 vaccine, and only a few of them were vaccinated against the COVID-19 virus. It is of utmost importance to design an evidence-based strategy to increase the uptake of vaccination for healthcare students and other nonhealth science students in universities.

Understanding the barriers and facilitators of vaccine hesitancy towards the COVID-19 vaccine in healthcare workers and healthcare students worldwide: An Umbrella Review

BACKGROUND

Healthcare workers (HCWs) and healthcare students display high levels of vaccine hesitancy with impact on healthcare provision, patient safety, and health promotion. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, this evidence needs to be synthesised, as interventions to reduce vaccination hesitancy in this population are needed.

METHODS

This Umbrella Review aimed to explore the barriers and facilitators of vaccine hesitancy toward the COVID-19 vaccine for HCWs and healthcare students. The review was performed and reported in accordance with Joanna Briggs Institutes guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A protocol was preregistered on PROSPERO (CRD42022327354). Eight databases were searched from November 2019 to 23rd May 2022 to identify any systematic reviews that explored factors associated with hesitancy towards the COVID-19 vaccine for HCWs or healthcare students.

RESULTS

A total of 31 studies were included in the review. The majority of studies (71%) were appraised as strong or moderate quality and there was a slight degree of overlap (<5%) of primary studies between the reviews. Vaccine hesitancy was more common among HCWs and healthcare students in specific occupational roles (e.g. nurses) than others (e.g. physicians). Frequent reasons for hesitancy were related to sociodemographic factors (gender, age, ethnicity), occupational factors (COVID-19 exposure, perceived risk, mandatory vaccination), health factors (vaccination history), vaccine-related factors (concerns about safety, efficacy, side-effects, rapid development, testing, approval and distribution of the vaccine), social factors (social pressure, altruism and collective responsibility), distrust factors (key social actors, pandemic management), information factors (inadequate information and sources, exposure to misinformation).

CONCLUSION

The results from this Umbrella Review have wide-reaching implications for the research area, healthcare systems and institutions and governments worldwide. Designing tailored strategies for specific occupational groups is pivotal to increasing vaccine uptake and securing a safe healthcare provision worldwide.

The effects of social-media based social comparison information and similarity mindsets on COVID-19 vaccination uptake cognitions

Vaccine hesitancy-delays in vaccine uptake when one is readily available-is an important public health issue. During the COVID-19 pandemic, the role of psychosocial factors in influencing cognitions and behaviors related to vaccine uptake have been examined. Using an online sample of unvaccinated U.S. adults (N = 300), we examined the influence of COVID-19-related social media-based comparison information (e.g., others' attitudes about taking the vaccine)-as well as the moderating impact of (dis)similarity mindsets and indirect influence of affective associations, norm perceptions, and self-evaluations of efficacy-on vaccination uptake intentions. Participants reported higher intentions for vaccine uptake following exposure to cautious comparison models (e.g., those that engaged in health prevention behaviors, intended to get vaccinated) versus risky comparison models (e.g., those who did not engage in health prevention behaviors, did not intend to get vaccinated) and neutral comparison models and this effect was indirect through positive affective associations about taking the vaccine. There were no main or interactive effects of (dis)similarity mindsets. Understanding the psychosocial factors that influence health cognitions and behaviors in the context of an infectious disease pandemic will advance theoretical development and aid in creating interventions targeting vaccine uptake.

Prevalence, Attitudes, and Factors Influencing Uptake of the COVID-19 Vaccine in Saudi Arabia

Background: The availability and access to COVID-19 vaccinations are critical to a successful pandemic response. More than 70% of the population reportedly needs to be vaccinated against COVID-19 to achieve herd immunity worldwide. However, the reluctance to get vaccinated with the COVID-19 vaccines is holding up the process of vaccination and efforts to control the pandemic and its negative consequences for the global health system, society, and economy. Previous studies have shown low uptake of vaccination in some Middle Eastern countries due to negative attitudes toward vaccination, including concerns about safety and efficacy and doubts about the need for vaccination. Aim: The aim of this study is to investigate the prevalence, attitudes, and factors influencing COVID-19 vaccine acceptance among healthcare workers, academic staff, and students in Saudi Arabia after the vaccine was made widely available by the government. Method: A cross-sectional survey was conducted to determine the prevalence, attitudes, and association between demographic factors and uptake of the first or second dose of vaccination among Saudi Arabian health workers and students. Data were collected using an online questionnaire administered and distributed through the Qualtrics platform. Results: The study recruited 173 participants from different countries and from different Saudi regions, most of whom were faculty members (n = 83). Results indicated significant differences between regions; the mean attitude score for the Western region (M 3.23) was significantly higher than that for other regions (M 3.08, p = 0.030). There was also an association between education level and number of vaccine doses received. Thus, the participants with higher education were the most compliant with national vaccination requirements (p = 0.004). Although the three professional groups reported social media as the most frequently reported source of information (p = 0.021), administrators were more likely to receive information from the MOH than other professional groups. Similarly, faculty members were more likely to receive information from colleagues and professional journals than the other two professional groups. Conclusions: Government officials should build public confidence through vaccination campaigns and devise effective health education programs to increase vaccination uptake. Authorized institutions can effectively use social media platforms to encourage vaccination and promote awareness among all audiences.

Perceptions of COVID-19 Vaccines: Protective Shields or Threatening Risks? A Descriptive Exploratory Study among the Italian Population

Although several quantitative studies have explored vaccine hesitancy, qualitative research on the factors underlying attitudes toward vaccination is still lacking. To fill this gap, this study aimed to investigate the general perceptions of COVID-19 vaccines among the Italian population with a qualitative approach. The sample included 700 Italian participants who completed an online survey. Open questions underwent a descriptive analysis for unveiling meaning categories, while differences in the prevalence of categories were calculated using chi-square or Fisher's exact tests. Vaccination was associated with the following seven main themes: 'safety', 'healthcare', 'vaccine delivery', 'progress', 'ambivalence', 'mistrust', and 'ethics'. Vaccinated individuals more frequently reported words related to the safety theme (χ2 = 46.7, p < 0.001), while unvaccinated individuals more frequently reported words related to mistrust (χ2 = 123, p < 0.001) and ambivalence (χ2 = 48.3, p < 0.001) themes. Working in the healthcare sector and being younger than 40 years affected the general perceptions of vaccination in terms of pro-vaccine attitudes. Unvaccinated individuals were more affected by the negative experiences of their acquaintances and manifested more distrust of scientific researchers, doctors, and pharmaceutical companies than vaccinated individuals. These findings suggest promoting collaborative efforts of governments, health policymakers, and media sources, including social media companies, in order to deal with cognitions and emotions supporting vaccine hesitancy.

Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework

COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.

Willingness to accept COVID-19 vaccine and its determinants in Ethiopia: A systematic review and meta-analysis

Introduction

Vaccination is one of the most crucial strategies in the control of pandemics such as COVID-19. Although a couple of research has been conducted to assess the willingness of the population to accept the COVID-19 vaccine, the findings are inconsistent and inconclusive. This study aimed to assess the pooled willingness to uptake the COVID-19 vaccine and its determinants in Ethiopia.

Methods

Published and unpublished articles were accessed from various electronic databases and digital libraries. A random-effects model was used to estimate the pooled effect size with a 95% confidence interval. Inverse variance (I2) was used to visualize the presence of heterogeneity. Publication bias was assessed using funnel plots and Egger’s statistical test.

Results

A total of 2345 studies were identified from several databases and 16 studies fulfilled the eligibility criteria and were included in the final meta-analysis. The pooled magnitude of willingness to accept the COVID-19 vaccine in Ethiopia was 55.19% (95% CI: 42.91, 67.48). The current meta-analysis indicated that age greater than 25 years (OR=1.49, 95% CI: 1.12, 1.98) and having a good attitude towards the COVID-19 vaccine (3.57, 95% CI: 1.46, 8.72) were significantly associated with the COVID-19 vaccine uptake.

Conclusions and recommendations

In general, the magnitude of the COVID-19 vaccine acceptance rate among the public is unacceptably low in Ethiopia. Therefore, there is a need to build public trust through the provision of reliable and consistent information about vaccines using different media outlets.

Applying two behavioral theories to predict the willingness to receive COVID-19 vaccine booster in the elderly: A cross-sectional study

BACKGROUND

The COVID-19 vaccination booster can effectively protect the elderly from infection while also lowering the risk of serious illness and death. However, barriers remain in willingness of the elderly to boost vaccination.

OBJECTIVE

Using the protection motivation theory (PMT) and the theory of planned behavior (TPB), to study the factors that influence willingness of the elderly to get the COVID-19 vaccine booster.

METHODS

The elderly who visited three randomly selected medical institutions in Nanjing's core urban region between March and April 2022 were chosen as study participants. A face-to-face survey was conducted using purposeful sampling and a self-designed questionnaire. The questionnaire contained sociodemographic characteristics, the elderly's willingness to obtain a COVID-19 vaccine booster, and psychosocial cognitive components based on the PMT and TPB. SmartPLS 3.0 was used to conduct structural equation modeling.

RESULTS

214 participants were included in the analysis. The combined model of the two behavioral theories explained the willingness to accept COVID-19 vaccine booster well with R2 of 0.490. Self-efficacy (β = 0.315) was the strongest predictor of vaccine booster willingness. Subjective norms (β = 0.160), perceived severity (β = 0.157), and perceived vulnerability (β = 0.159) also showed positive effects on vaccine booster willingness, while response cost (β = -0.143) had a negative effect on the willingness. No significant association between attitudes, response efficacy and the willingness was discovered.

CONCLUSION

The willingness of the elderly to receive the COVID-19 vaccine booster was affected by psychosocial cognitive factors. This study supports the applicability of the PMT and TPB models to interpret the willingness of the elderly in such areas.

Exploring the Influencing Factors of COVID-19 Vaccination Willingness among Young Adults in China

Vaccine uptake is considered as one of the most effective methods of defending against COVID-19 (coronavirus disease 2019). However, many young adults are hesitant regarding COVID-19 vaccines, and they actually play an important role in virus transmission. Based on a multi-theory model, this study aims to explore the influencing factors related to COVID-19 vaccine willingness among young adults in China. Using semi-structured interviews, this study explored the factors that would motivate young adults with vaccine hesitancy to get the COVID-19 vaccine. Thematic analysis was used to analyze the interview data with topic modeling as a complementarity method. After comparing the differences and similarities of results generated by thematic analysis and topic modeling, this study ultimately identified ten key factors related to COVID-19 vaccination intention, including the effectiveness and safety of vaccines, application range of vaccine, etc. This study combined thematic analysis with machine learning and provided a comprehensive and nuanced picture of facilitating factors for COVID-19 vaccine uptake among Chinese young adults. Results may be taken as potential themes for authorities and public health workers in vaccination campaigns.

Identifying and Evaluating the Socioeconomic Factors of COVID Vaccine Hesitancy Through an Integrated Multicriteria Decision Analysis Approach

The governments have been facing the challenges to develop tailored strategies to decrease COVID vaccine hesitancy (CVH) and refusal and increase the acceptability and uptake to ensure the protection of public health. In Pakistan, it has been a great challenge for the government to increase the acceptability of the COVID vaccine. CVH has been a great hurdle to achieving this objective. The authors found it imperative to identify and evaluate the factors of CVH in Pakistan. For this purpose, the authors used an integrated multicriteria decision analysis method (MCDM) by combining Delphi and DEMATEL methods. The factors of CVH have been identified and finalized using the Delphi method. The experts' opinions were obtained to evaluate the factors. The DEMATEL method was used to find out the most critical factor(s) of CVH. Moreover, the cause/effect relationship was also developed to have a better understating of factors and their relationships. The analysis revealed "ineffective public awareness strategies" as the most critical factor of CVH followed by "misinformation and disinformation, conspiracy theories", and "acquired knowledge". The study also examined the cause-and-effect relationship between the prioritized factors. The government in Pakistan introduced successful efforts to deal with the COVID-19 pandemic, yet the government could do more to increase vaccine acceptance. For this purpose to serve effective scientific and evidence-based public awareness strategies are needed to increase the acquired knowledge and deal with misinformation, disinformation, and conspiracy theories to increase vaccine acceptance. The government could sue the media, especially social media to increase vaccination. The findings of the study provide a detailed understanding of the CVH in Pakistan and develop a comprehensive public health strategy to deal with any health-related potential issues in the future.

Demands for Community Services and Associated Factors among Residents in Smart Communities: A Case Study of Xuzhou City

Smart community enables a sustainable and livable community future, in which residents' demands play an important role in its success. Though great efforts have been made to encourage residents' participation in the implementation of smart communities, inefficient service supply still exists. Thus, this study aimed to classify residents' demands for community services in smart communities and to explore relevant influencing factors based on the developed conceptual framework. Data from 221 respondents in Xuzhou city of China were analyzed by using binary logistic regression. The results indicated that more than 70% of respondents had demands for all community services in smart communities. Moreover, the demands were influenced by distinct factors, including sociodemographic characteristics, living characteristics, economic characteristics, and individual attitude characteristics. The types of community services in smart communities are clarified and fresh insights are provided into associated factors related to residents' demands for these services in this study, through which enhanced provision of community services and effective implementation of smart communities can be achieved.

Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role?

BACKGROUND

COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions.

METHOD

We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (

RESULTS

Of the 591 parents in this sample, 49% indicated that they intended to vaccinate their child(ren), 29% reported that they would not, and 21% were undecided. In bivariate analyses, race/ethnicity, health insurance, flu vaccination in the past 12 months, and parental COVID-19 vaccination status were significantly related to parental intention to vaccinate their child(ren). In the multivariable analyses, which controlled for these factors, parents who intended to vaccinate their child(ren) had greater confidence in their ability to make informed decisions about COVID-19 vaccinations compared to those who were unsure about vaccination. Each one standard deviation in the Decision Self-Efficacy score was associated with a 39% increase in intention to vaccinate one's child versus being unsure about vaccination (AOR 1.39, 95% CI 1.09, 1.77).

CONCLUSIONS

Parents who are unsure about vaccinating their children against COVID-19 may benefit from interventions designed to increase their ability to obtain, understand, and utilize information to make informed decisions.

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Key Words

• SARS-CoV-2 (COVID-19)
• decision self-efficacy
• health behaviors
• parents
• vaccination
• vaccine confidence

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MESH Headings Collapse

Grants

• U54MD007601 NIH HHS
• U54 MD007601 NIMHD NIH HHS

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Affiliation(s)

Jennifer D. Allen Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Ave, Medford, MA 02155, USA
Masako Matsunaga Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Eunjung Lim Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Gregory D. Zimet Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, USA
Kimberly H. Nguyen Department of Public Health and Community Medicine, Tufts University Medical School, 136 Harrison Ave, Boston, MA 02111, USA
Holly B. Fontenot Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA

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COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis

INTRODUCTION

People affected by diabetes are at higher risk for complications from certain vaccine-preventable diseases. Suboptimal vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of diabetic patients who express hesitation to the COVID-19 vaccine worldwide.

METHODS

Seven studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases from 2020 to 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (diabet*).

RESULTS

The vaccine hesitation rate among persons with diabetes was 27.8 % (95 %CI = 15.6-41.9 %). In the comparison of vaccine hesitancy between sexes and educational status, the RRs were 0.90 (95 %CI = 0.71-1.15) and 0.88 (95 %CI = 0.76-1.02), respectively. The main reasons of unwillingness were lack of information, opinion that the vaccine was unsafe or not efficient, and fear of adverse events.

CONCLUSIONS

In order to achieve a high vaccination coverage, multifactorial approach is needed, which requires major social, scientific and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented.

A longitudinal assessment of variability in COVID-19 vaccine hesitancy and psychosocial correlates in a national United States sample

Recent evidence suggests that COVID-19 vaccine hesitancy is not static. In order to develop effective vaccine uptake interventions, we need to understand the extent to which vaccine hesitancy fluctuates and identify factors associated with both between- and within-person differences in vaccine hesitancy. The goals of the current study were to assess the extent to which COVID-19 vaccine hesitancy varied at an individual level across time and to determine whether disgust sensitivity and germ aversion were associated with between- and within-person differences in COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 1025; 516 woman; M_age = 46.34 years, SD_age = 16.56, range: 18 to 85 years; 72.6 % White) completed six weekly online surveys (March 20 - May 3, 2020). Between-person mean COVID-19 vaccine hesitancy rates were relatively stable across the six-week period (range: 38-42 %). However, there was considerable within-person variability in COVID-19 vaccine hesitancy. Approximately, 40 % of the sample changed their vaccine hesitancy at least once during the six weeks. There was a significant between-person effect for disgust sensitivity, such that greater disgust sensitivity was associated with a lower likelihood of COVID-19 vaccine hesitance. There was also a significant within-person effect for germ aversion. Participants who experienced greater germ aversion for a given week relative to their own six week average were less likely to be COVID-19 vaccine hesitant that week relative to their own six-week average. This study provides important information on rapidly changing individual variability in COVID-19 vaccine hesitancy on a weekly basis, which should be taken into consideration with any efforts to decrease vaccine hesitancy and increase vaccine uptake. Further, these findings identify-two psychological factors (disgust sensitivity and germ aversion) with malleable components that could be leveraged in developing vaccine uptake interventions.

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

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

Factors related to COVID-19 vaccine hesitancy in Denmark: A national study in the autumn of 2021

AIMS

The novelty of the COVID-19 pandemic and fast-developed vaccines may increase concerns about the safety and effectiveness of the COVID-19 vaccine and thereby influence vaccine hesitancy. The aims of this study were to examine (a) the main reasons for COVID-19 vaccine hesitancy and (b) factors associated with COVID-19 vaccine hesitancy.

METHODS

A nationwide survey was conducted in the autumn of 2021 when most Danes had received at least one dose of a COVID-19 vaccine. The sample (N=13,570) was based on a random selection of individuals (⩾15 years), and data were collected via self-administered mailed questionnaires (digital and physical). The participants were asked whether they had been vaccinated against COVID-19, and if they had not, they were asked about their reasons for vaccine hesitancy. Logistic regression models were used to determine factors associated with vaccine hesitancy.

RESULTS

In all, 5,384 (39.7%) individuals completed the questionnaire. The main reasons for vaccine hesitancy were worries about adverse effects (57.6%) and the belief that natural immunity is better than vaccination (43.8%). Factors associated with vaccine hesitancy included female sex, younger age, being divorced, a country of origin other than Denmark, lower educational level, being unemployed, previously infected with COVID-19 and being worried to a greater extent about oneself and others getting infected. Mental health indicators were not associated with vaccine hesitancy.

CONCLUSIONS

COVID-19 vaccine hesitancy is likely to pose a challenge for population immunity. To reduce vaccine hesitancy and increase vaccination uptake, future vaccination programmes should focus on specific socio-demographic subgroups identified in this study.

COVID-19 vaccine hesitancy in the Saudi Arabian population

This study aimed to measure the level of vaccine hesitancy among the Saudi population using the WHO Vaccine Hesitancy Scale (VHS). A cross-sectional study using a modified vaccine hesitancy scale (VHS) was conducted among Saudi Arabian residents between April 4 and May 24, 2021. The relationship between participants' willingness to uptake COVID-19 vaccines and their demographics, awareness of COVID-19, and health status was evaluated. The chi-square test was employed to compare categorical variables and logistic regression for the associations of demographical characteristics with acceptance of the vaccine. We received a total of 1657 completed responses. 1,126 participants (68%) were vaccinated, of which 19% were vaccinated with one dose only, and 49% were fully vaccinated (with two doses). Safety concerns and worries about side effects were higher among the hesitant group (p<0.001). 96% of the participants from the willing group were not hesitant to have the vaccine, whereas in the same group, 70% thought they had good health and the vaccine was not needed. Logistic regression analysis revealed that participants with chronic diseases had lower odds of being willing to be vaccinated (OR=0.583, p-value 0.04). The study findings suggest key factors associated with COVID-19 vaccine hesitancy in the Saudi population and can help public health authorities plan strategies to minimize vaccine hesitancy and improve awareness about vaccine acceptance.

Determinants of vaccine acceptance, knowledge, attitude, and prevention practices against COVID-19 among governmental healthcare workers in Addis Ababa and Adama, Ethiopia: A cross-sectional study

Background and Aims

COVID-19 vaccines are vital tools for infection prevention and control of the pandemic. However, coronavirus immunization requires acceptance among healthcare workforces and by the community. In Ethiopia, studies focused on determinants of vaccine acceptance, knowledge, attitude, and prevention practices (KAP) contrary to the novel coronavirus among healthcare staff are limited. Hence, closing this gap requires research.

Methods

A cross-sectional study was conducted on 844 governmental healthcare workers. A stratified, simple random sampling technique was used to select the respondents. Data were collected using a structured questionnaire. Binary and multivariable logistic regression statistical models were used to analyze the data.

Results

This study indicated that only 57.9% of the participants had good COVID-19 vaccine acceptance, meaning they took at least a dose of the vaccine themselves. We found that 65%, 60.9%, and 51.3% of the participants had good knowledge, prevention practices, and attitude against the pandemic. The novel coronavirus vaccine acceptance rate was 2.19 times more likely among females (adjusted odds ratio [AOR] = 2.19 with 95% confidence interval [CI]: 1.54-3.10) than among male participants. Further, respondents who did not report having any chronic diseases were 9.40 times higher to accept COVID-19 vaccines (AOR = 9.40 with 95% CI: 4.77, 18.53) than those who reported having a chronic condition. However, healthcare workers who had a habit of chewing khat at least once per week were 4% less likely to take the vaccine (AOR = 0.04 with 95% CI: 0.01, 0.32) than those who had no habit of chewing khat.

Conclusion

Many core factors influencing COVID-19 vaccine acceptance were identified. A significant number of participants had poor vaccine acceptance, KAP against COVID-19. Therefore, the government should adopt urgent and effective public health measures, including public campaigns to enhance public trust in COVID-19 vaccines. In addition, continuous, timely, and practical training should be provided to healthcare workers.

COVID-19 vaccine hesitancy among Italian people with multiple sclerosis

INTRODUCTION

Vaccine hesitancy promotes the spread of infectious diseases including COVID-19 virus, limiting the herd immunity. Complications caused by COVID-19 in people with multiple sclerosis forced governments to ensure them prior access to vaccinations. Their propensity to be vaccinated needs to be assessed to promote adhesion to vaccination programs. The aim of this study was to explore the COVID-19 vaccine hesitancy rate in pwMS.

METHODS

We conducted an observational study recruiting patients affected by multiple sclerosis followed at MS Clinical and Research Unit of Tor Vergata University, Rome. We invited them to fill in an online survey about their intent to get COVID-19 vaccination. Fisher's exact test and Kruskal-Wallis test were performed to explore differences in sociodemographic, clinical, and emotional variables relative to the opinions about vaccinations. An exploratory factor analysis (EFA) was performed to assess the factorial structure of the questionnaire; Pearson's correlations between the factors and Big Five personality dimensions were also calculated.

RESULTS

Of 276 respondents, 90% was willing to get vaccinated, while only 1.4% was sure to refuse the vaccination. Education level, opinions on safety and efficacy of vaccines, and emotional status were found to be associated to the propensity of getting the COVID-19 vaccination (respectively: p = 0.012, p < 0.001, and p = 0.0001). Moreover, general opinions on healthcare system were related to the intention to get vaccinated.

CONCLUSION

Our results reinforce the importance of a good relationship between doctor and patient and the need to adapt doctors' communication strategy to patients' personalities and beliefs.

Low Response to the COVID-19 Vaccine Among the Arab Population in Israel: Is It a Cultural Background, or a Systemic Failure, or Maybe Both?

INTRODUCTION

A low response to COVID-19 vaccination was observed among the Arab population in Israel. Efforts to improve this achieved moderate results.

OBJECTIVES

The aim of this study was to examine the extent to which demographic and cultural factors, the media, trust, perceptions, and government policies influence the willingness of Arabs to be vaccinated against COVID-19.

METHODS

A cross-sectional survey was conducted among Israeli Arabs (558 respondents). The questionnaire was distributed through social networks between January 16 and 26, 2021. The t-tests, Chi-square tests, Z tests, which were used to evaluate the significance of variables, and Pearson correlations calculated for the study variables were used for statistical analysis. Hierarchical logistic regression was calculated to assess the extent of background influence on the odds for vaccination, and mediation was examined using the Process procedure.

RESULTS

Moderate means were found for attitudes towards vaccination, vulnerability, vaccine effectiveness, and pandemic fatigue. A lower score was found for accessibility to medical services, social norms, and emotional barriers. Trust was highest in health-related authorities, whereas trust in government and the media was the lowest. Higher pandemic fatigue was associated with lower trust and lower odds for vaccination.

DISCUSSION

Lack of awareness of the specific needs of the Arab minority in Israel, lack of vaccination campaigns in Arabic language, long neglect of Arabs in the Israeli health system, mistrust of governmental authorities by the Arabs, and low socioeconomic background of Israeli Arabs might have led to lower trust levels and incompliance with governmental policies among Arabs. Addressing these issues may benefit the entire population. The authors believe that "A chain (in population health) is only as strong as its weakest link."

Differences between COVID-19-vaccinated and unvaccinated participants from Croatia

AIM

To compare Croatian participants vaccinated against coronavirus disease 2019 (COVID-19) and unvaccinated participants in terms of socio-demographic, personal, social, and COVID-19-related variables.

METHODS

From August till December 2021, 721 (465 vaccinated and 256 unvaccinated) participants completed an online survey about socio-demographic (age, sex income, education, marital status), personal (well-being indicators, personality measures and health), social (trust in experts, trust in government), and COVID-19-related characteristics (fear of COVID-19, history of COVID-19 infection). Differences between the groups were assessed with discriminant analysis.

RESULTS

The variables that best discriminated between vaccinated and unvaccinated participants were higher trust in experts, no history of COVID-19 infection, older age, higher fear of COVID-19, and intellect. Conclusion The study points to the importance of trust in experts in the promotion of COVID-19 vaccine.

Concerns about and stimuli of COVID-19 vaccination hesitancy among diverse occupational groups in metropolitan areas of China: a cross-sectional study

OBJECTIVES

In this study, we aimed to identify concerns and stimuli regarding COVID-19 vaccination acceptance and to compare the findings by occupation.

METHODS

We conducted a cross-sectional study of individuals vaccinated against COVID-19 between 1 April and 30 June 2021 in four metropolitan areas of China. A total of 20 863 participants completed questionnaires, 20 767 of which were eligible for analysis. We used ordered logistic regression to assess the association of vaccination concerns and stimuli with vaccination hesitancy according to occupation.

RESULTS

Farmers were mainly concerned about the quality of vaccines (adjusted OR (aOR): 3.18, 95% CI (CI): 1.83 to 5.54). Among civil servants, media publicity reduced hesitancy (aOR: 0.44, 95% CI: 0.21 to 0.92). Among medical staff, concerns about a short duration of protective effects increased hesitancy (aOR: 8.31, 95% CI: 2.03 to 33.99). For most occupations, concerns about side effects, poor protective effects and health status increased hesitancy. In contrast, protecting oneself and protecting others acted as a stimulus to decrease hesitancy. Interestingly, 'people around me have been vaccinated' was associated with higher vaccination hesitancy among farmers (aOR: 2.19, 95% CI: 1.20 to 4.00).

CONCLUSION

The association of vaccination concerns and stimuli with vaccination hesitancy varied by occupation. The characteristics and concerns of specific target audiences should be considered when designing informational campaigns to promote vaccination against COVID-19.

Parental attitudes towards vaccination against COVID-19 of children 5-11 years old in Greece

RATIONALE

Vaccinating children against COVID-19 is critical to contain the ongoing pandemic.

AIMS/OBJECTIVES

The aim of the present study was to assess parents' and caregivers' intention to vaccinate their 5-11 years old children against COVID-19 and to estimate the association between vaccination intention and sociodemographic, clinical and contextual factors.

METHOD

We conducted a questionnaire-based survey on a convenience sample of parents in Patras, Western Greece.

RESULTS

Out of 366 study participants, around 48% reported their intention to vaccinate their child. The main factors associated with positive attitudes were paediatrician recommendation, parental vaccination, and reliance on the healthcare providers for decision making. Of note, 80% of the 190 parents who did not intend to vaccinate their children would vaccinate them if the paediatrician recommended it.

CONCLUSION

Interventions to further train healthcare professionals to establish rapport with parents, and to provide adequate information about vaccinations are crucial to address concerns related to COVID-19 vaccine benefits for children.