Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States

Watchful, skeptics, and system distrusters: Characteristics associated with different types of COVID-19 vaccine hesitancy among U.S. working-age adults

COVID-19 vaccine hesitancy is complex, with adults identifying various reasons for not getting vaccinated. Using data from the 2022 National Wellbeing Survey on 7612 U.S. adults aged 18-64, we identified how age, race/ethnicity, sex, marital status, education, income, employment status, partisanship, and metropolitan status are associated with COVID-19 vaccination status and three non-mutually exclusive types of vaccine hesitancy: 1) watchful, concerned about vaccine side effects and efficacy; 2) skeptics, distrust the vaccine, and 3) system distrusters, distrust government. A third of respondents overall (N = 2643) had not received at least one dose at the time of the survey. Among respondents who were not vaccinated, 67 % are classified as watchful, 53 % are skeptics, and 32 % are system distrusters. Results from logistic regression show that concerns about side effects and safety (watchfulness) appear to be major drivers for not getting vaccinated among females and among non-Hispanic Black and unmarried adults, whereas skepticism and distrust appear to be more important barriers among ages 25-44. All three types of hesitancy appear to be important contributors to lower vaccination uptake among low-income, low-education, and unemployed adults, and among individuals who voted for Donald Trump in the 2020 election (with skepticism and distrust being most endorsed by this group). Findings suggest that universal messaging and intervention strategies are unlikely to be effective in reducing vaccine hesitancy. Different messages, messengers, and tactics must be used with different groups.

Understanding Vaccine Hesitancy in U.S. Prisons: Perspectives from a Statewide Survey of Incarcerated People

Much of the American response to the COVID-19 pandemic was characterized by a divergence between general public opinion and public health policy. With little attention paid to individuals incarcerated during this time, there is limited direct evidence regarding how incarcerated people perceived efforts to mediate the harms of COVID-19. Prisons operate as a microcosm of society in many ways but they also face unique public health challenges. This study examines vaccine hesitancy-and acceptance-among a sample of individuals incarcerated within adult prisons in Pennsylvania. Using administrative records as well as rich attitudinal data from a survey of the incarcerated population, this study identifies a variety of social and historical factors that are-and are not-associated with an incarcerated person's willingness to receive the COVID-19 vaccine. Our findings highlight vaccination challenges unique to the carceral context and offer policy recommendations to improve trust in credible health messengers and health service provision for this often overlooked but vulnerable population.

Socio-demographic determinants of COVID-19 vaccine uptake in Ontario: Exploring differences across the Health Region model

The COVID-19 pandemic continues to be a worldwide public health concern. Although vaccines against this disease were rapidly developed, vaccination uptake has not been equal across all the segments of the population, particularly in the case of underrepresented groups. However, there are also differences in vaccination across geographical areas, which might be important to consider in the development of future public health vaccination policies. In this study, we examined the relationship between vaccination status (having received the first dose of a COVID-19 vaccine), socio-economic strata, and the Health Regions for individuals in Ontario, Canada. Our results show that between October of 2021 and January of 2022, individuals from underrepresented communities were three times less likely to be vaccinated than White/Caucasian individuals across the province of Ontario, and that in some cases, within these groups, individuals in low-income brackets had significantly higher odds of vaccination when compared to their peers in high income brackets. Finally, we identified significantly lower odds of vaccination in the Central, East and West Health Regions of Ontario within certain underrepresented groups. This study shows that there is an ongoing need to better understand and address differences in vaccination uptake across diverse segments of the population of Ontario that the pandemic has largely impacted.

Attitudes toward COVID-19 vaccines during pregnancy and breastfeeding

Background

Although vaccination is one of the most effective means of controlling the spread of COVID-19, public concerns and indecision about vaccination still continue. Because pregnant and breastfeeding individuals are at high risk for severe outcomes in case of infections, determining their level of hesitation and attitude toward COVID-19 vaccines will guide the management of the disease. This study aimed to determine pregnant and breastfeeding women's levels of hesitation and attitude toward COVID-19 vaccines as well as their related factors.

Methods

The sample of this descriptive research consisted of 103 pregnant or breastfeeding individuals who were seen at the obstetrics and gynecology outpatients clinic of a state hospital in Istanbul, Turkey. The data were collected using a 'demographic data form', the 'Vaccine Hesitancy Scale in Pandemic', and the 'Attitudes toward COVID-19 Vaccine Scale'. The research data were analyzed with appropriate statistical methods.

Results

The mean age of the participants was 29.71 ± 4.75, 51% were pregnant, and 74.8% had received the COVID-19 vaccine. The mean score of the 'Vaccination Hesitancy Scale in Pandemic' was 30.83 ± 6.91, and the mean score for the 'Attitude Scale toward the COVID-19 Vaccine' was 25.50 ± 5.20. A significant difference was found between the total score of the 'Vaccine Hesitation Scale in the Pandemic' and the mean score of the 'Lack of Confidence' sub-dimension between the 'working status' and the 'influenza vaccination' status. In terms of the mean score of the 'Risk' sub-dimension, a significant difference was found between the 'period of vaccination' (p < 0.05). According to the mean total score of the 'Attitude Towards COVID-19 Vaccine Scale', there was a significant difference between the 'smoking' status. There was a significant difference in the 'Positive Attitude' sub-dimension in terms of the 'flu vaccination' status. There was a significant difference in the 'Negative Attitude' sub-dimension in terms of the 'chronic disease' status. A positive correlation was found between the total scores of the scales.

Conclusion

It was concluded that although the participants had a high level of hesitation toward the COVID-19 vaccine, they had a positive attitude. The results obtained will be guided in determining the strategies to be developed for these specific groups in future pandemics.

A Scoping Review on Gender/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States

OBJECTIVE

To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic.

DATA SOURCE

Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake.

DATA EXTRACTION

Three authors screened studies and extracted data.

DATA SYNTHESIS

Univariate and multivariate results are summarized.

RESULTS

A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men's greater intentions to vaccinate compared to women, and men's greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses.

CONCLUSION

Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.

Modification of the Public Attitude Towards Vaccination Scale for use in adult vaccines

BACKGROUND

Vaccination is a crucial protective intervention to prevent adult mortality and morbidity. Personal perceptions and resources have an important place in the vaccination decision.

AIM

This study aimed to modify the Public Attitude Towards Vaccination-Health Belief Model scale for adult vaccines and evaluate its psychometric properties.

METHODS

Overall, 626 people participated in this methodological study. Content validity index, confirmatory factor analysis, internal consistency and item-total score correlation were used for validity and reliability. The independent samples t test, logistic regression analysis and ROC analysis were used for criterion and concurrent validity.

RESULTS

In confirmatory factor analysis, values of fit indices were excellent or acceptable. The Cronbach alpha value was between 0.83 and 0.92. According to criterion validity, the susceptibility, severity, benefit, and health motivation scores of those with the vaccine were higher than those without, whereas their barrier score was lower. The barrier subscale was a risk factor, whereas the benefit score was a protective factor that increased the likelihood of vaccination. The concurrent validity of the scale was tested with the COVID-19 vaccine. While the barrier subscale's ability to distinguish between vaccinated (specificity) and unvaccinated (sensitivity) individuals is excellent, it is acceptable for the other subscales.

CONCLUSION

Modified PAVS-HBM is valid and reliable for adult vaccines. This scale was associated with vaccination behaviour and distinguished between vaccinated and unvaccinated individuals.

Potential determinants of parental hesitancy to vaccinate their children against COVID-19 infection: a cross-sectional investigation

Coronavirus disease 2019 (COVID-19) vaccination hesitancy has emerged as a substantial concern among the adult population globally. However, limited evidence is available about parental hesitancy to vaccinate their children against COVID-19 within the Pakistani context. Thus, the present investigation aimed to assess parental attitudes, perceptions, and willingness regarding vaccination hesitancy and associated predictors of getting their children vaccinated against COVID-19. We conducted a cross-sectional population-based, self-administered online questionnaire in Punjab, Pakistan, on randomly selected parents between October 2022 and February 2023. The data were collected based on socio-demographics, attitudes, perceptions, and willingness of parents regarding COVID-19 vaccine hesitancy for their children. Adjusted odds ratios with 95% confidence intervals were estimated to identify the predictors of vaccine hesitancy. The findings demonstrated that among 1,478 participants, a total of 40% believed that the COVID-19 vaccine may pose a greater risk to children than adults, while 38% exhibited no concerns. Around 13% of children were not vaccinated in our study sample. More than half expressed hesitancy toward vaccination, and only 35.25% were inclined to get their children vaccinated in our study sample. In addition, only 16% of the parents believed that the COVID-19 vaccination may cause an alteration in their children's DNA. A similar proportion of parents were aware of the significance of getting their children vaccinated and expressed their willingness to vaccinate their children to prevent the COVID-19 infection. However, a higher odds ratio was observed in females with a higher educational background and those in the healthcare profession. In conclusion, healthcare awareness-supporting programs for educating parents should be designed and implemented. These insights might aid in the development of strategies to eradicate barriers in existing coronavirus vaccination programs and may vaccinate a larger child population to reduce the adverse consequences of the pandemic.

Acceptance of a Future Gonorrhea Vaccine in a Post-Coronavirus Disease 2019 World: Impact of Type of Recommendation and Changing Levels of Trust in Health Institutions and Authorities

Widespread uptake of a future gonorrhea vaccine could decrease the burden of disease and limit the spread of antibiotic resistance. However, gonorrhea vaccination will occur in the backdrop of the roll-out of the coronavirus disease 2019 (COVID-19) vaccine, which could have influenced parental perceptions about other, non-COVID-19 vaccines. In an internet-based cross-sectional survey, 74% of parents would get a gonorrhea vaccine for their child, and this was higher among those whose trust in pharmaceutical companies increased since the start of the COVID-19 pandemic. About 60% of adults aged 18 to 45 would receive a vaccine for themselves.

Can delay discounting predict vaccine hesitancy 4-years later? A study among US young adults

Despite being a major threat to health, vaccine hesitancy (i.e., refusal or reluctance to vaccinate despite vaccine availability) is on the rise. Using a longitudinal cohort of young adults (N = 1260) from Los Angeles County, California we investigated the neurobehavioral mechanisms underlying COVID-19 vaccine hesitancy. Data were collected at two time points: during adolescence (12th grade; fall 2016; average age = 16.96 (±0.42)) and during young adulthood (spring 2021; average age = 21.33 (±0.49)). Main outcomes and measures were delay discounting (DD; fall 2016) and tendency to act rashly when experiencing positive and negative emotions (UPPS-P; fall 2016); self-reported vaccine hesitancy and vaccine beliefs/knowledge (spring 2021). A principal components analysis determined four COVID-19 vaccine beliefs/knowledge themes: Collective Responsibility, Confidence and Risk Calculation, Complacency, and Convenience. Significant relationships were found between themes, COVID-19 vaccine hesitancy, and DD. Collective Responsibility (β = -1.158[-1.213,-1.102]) and Convenience (β = -0.132[-0.185,-0.078]) scores were negatively associated, while Confidence and Risk Calculation (β = 0.283[0.230,0.337]) and Complacency (β = 0.412[0.358,0.466]) scores were positively associated with COVID-19 vaccine hesitancy. Additionally, Collective Responsibility (β = -0.060[-0.101,-0.018]) was negatively associated, and Complacency (β = -0.063[0.021,0.105]) was positively associated with DD from fall 2016. Mediation analysis revealed immediacy bias during adolescence, measured by DD, predicted vaccine hesitancy 4 years later while being mediated by two types of vaccine beliefs/knowledge: Collective Responsibility (β = 0.069[0.022,0.116]) and Complacency (β = 0.026[0.008,0.044]). These findings provide a further understanding of individual vaccine-related decision-making among young adults and inform public health messaging to increase vaccination acceptance.

A comparison of electronic health records and the Oregon state immunization registry for human papilloma virus vaccine delivery (2005-2022)

INTRODUCTION

Immunization Information Systems (IIS) play an important information-sharing role at the point of care, and provide vital vaccination data for research studies and policy-makers. Previous validation studies comparing the accuracy of state registry data to health records have had mixed results.

METHODS

We conducted a retrospective review of EHR vaccination data for 9-17 year-old patients from 10 Oregon primary care clinics who had at least one ambulatory care visit in the past 3 years from the date of validation data collection. Data on 100 age eligible youth were captured per clinic. We compared HPV and Tdap vaccinations captured in the EHR to the Oregon ALERT IIS. All clinics were located in rural areas with both family medicine (n = 7) and pediatric (n = 3) primary care clinics.

RESULTS

Overall agreement for HPV vaccination between EHR and ALERT IIS was 89.4 % (k = 0.83; p < 0.05). For Tdap vaccination overall agreement was 80.8 % (k = 0.60; p < 0.05). Pediatric clinics showed a higher overall vaccine agreement for both HPV at 93.3 % (k = 0.89; p < 0.05) and Tdap at 95.3 % (k = 0.90; p < 0.05). Among clinics that used bidirectional data exchange (only family medicine clinics), HPV agreement was higher at 91 % (k = 0.85) versus 88 % (k = 0.81; p < 0.05) and was lower for Tdap 75 % with bidirectional data exchange (k = 0.50) versus 86 % without bidirectional data exchange (k = 0.70; p < 0.05). When the EHR and ALERT IIS disagreed, ALERT ISS usually had additional vaccines.

CONCLUSIONS

ALERT IIS data provides more accurate data than EHRs can provide when measuring vaccine delivery among adolescents in rural Oregon.

COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults

PURPOSE

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups.

METHODS

We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake.

FINDINGS

At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination.

CONCLUSIONS

By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences

Background

Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases.

Methods

We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video.

Results

Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns.

Conclusion

Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.

Predictors of Pediatric COVID-19 vaccination: a case-control study in Tabriz, Iran

INTRODUCTION

COVID-19 vaccination of children can help reduce the severity of the infection and the death rate caused by it and also helps achieve herd immunity. The level of acceptance and high vaccination coverage is the main elements in the success of immunization programs. Children's vaccination is dependent on their parent's decision. This study aims to identify predictors of the children's COVID-19 vaccination accomplishment by their parents.

METHOD

In this case-control study, 577 vaccinated children as cases and 366 un-vaccinated children as controls were randomly selected from the general population of Tabriz, Iran 2022, and their data were collected by telephone calls and interviews with the children's parents. Cases and controls were compared in terms of clinical and demographic factors of the child as well as the socioeconomic status (SES) of their parents by using a multivariable mixed-effect logistic regression model.

RESULTS

According to the results of the multivariable logistic regression, the age of the child (OR = 1.26 95% CI (1.14, 1.40), p-value < 0.001), previous COVID-19 infection of the child (OR = 1.92, 95% CI (1.21, 3.04), p-value < 0.001), having no underlying disease in the child (OR = 1.76, 95% CI (1.02, 3.02), p-value = 0.04), the dwelling place of the household (the high-level dwelling in compared to a low level (OR = 3.34, 95% CI (1.6, 6.64), p-value = 0.001), the middle level of dwelling compared with low level (OR = 4.87, 95% CI (2.46, 9.51), p-value < 0.001)), and Father's job (Employee and technician Fathers compared to worker fathers (OR = 2.99, 95% CI (1.55, 5.77), p-value = 0.001)) were significant independent predictors of children COVID-19 vaccination.

CONCLUSION

Several demographic and socioeconomic factors were associated with children's vaccination. Older children, children without any underlying disease, children with a history of COVID-19 infection, and children of parents with higher levels of SES were more likely to receive the COVID-19 vaccine. This finding can be considered in children's vaccination policymaking.

Racial residential segregation and COVID-19 vaccine uptake: an analysis of Georgia USA county-level data

BACKGROUND

Foundational literature demonstrates that racial residential segregation results in poorer health outcomes for Black people than white people due to a variety of social determinants of health. COVID-19 vaccine uptake is important for better health outcomes, regardless of race. The COVID-19 pandemic has elevated concerns about racial health disparities but with little discussion of racial residential segregation as a predictor of disparate health outcomes. This paper investigates the relationship between racial residential segregation and COVID-19 vaccine uptake using county level data from the State of Georgia (USA).

METHODS

Using publicly available data, regression analysis is conducted for 138 of the 159 counties in Georgia USA, using a dissimilarity index that describes county level differences in racial residential segregation. The primary independent variable is Black-white differences in vaccine uptake at the county level. The analytic methods focus on a spatial analysis to support information for county level health departments as the basis for health policy and resource allocation.

RESULTS

Constructing a variable of the difference in vaccination rates between Black and white residents we find that Black-white differences in COVID-19 vaccination are most notable in the 69 most segregated of the 159 counties in Georgia. A ten-point lower segregation index is associated with an improvement in the Black-white vaccination gap of 1.5 percentage points (95% CI -0.31, -0.00). Income inequality and access to health care resources, such as access to a primary care physician, also predict Black-white differences in vaccination rates at the county level. Suggested mapping approaches of publicly available data at a state county level, provides a resource for local policy makers to address future challenges for epidemic and pandemic situations.

CONCLUSION

County level and geospatial data analysis can inform policy makers addressing the impact of racial residential segregation on local health outcomes, even for pandemic and epidemic issues.

COVID-19 Virus and Vaccination Attitudes among Healthcare Workers in Michigan: A Cross-Sectional Study

BACKGROUND

Defining the characteristics of healthcare worker (HCW) attitudes toward the coronavirus disease 2019 (COVID-19) vaccine can provide insights into vaccine hesitancy. This study's goal is to determine HCWs' attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy.

METHODS

This cross-sectional study surveyed HCWs working in institutions in Saginaw, Sanilac, and Wayne counties in Michigan (N = 120) using tipping-scale questions. Analysis of variance and t-test were used to measure HCWs' attitudes toward the COVID-19 virus and vaccines.

RESULTS

Most HCWs received (95.9%) and recommended (98.3%) a COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine were: (1) efficacy of the vaccine, (2) current exposure to patients with active COVID-19 infection and risk of virus spread, and (3) safety of vaccine and long-term follow-up. Female HCWs or HCWs aged 25-54 years were more concerned about contracting COVID-19. Physicians or HCWs aged 55-64 were less concerned regarding the effectiveness and side effects of the vaccine.

CONCLUSIONS

Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among COVID-19 attitudes. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

Post-traumatic stress disorder, anxiety, depression and burnout in nursing home staff in South France during the COVID-19 pandemic

The high mortality rate in nursing homes during the COVID-19 pandemic may be linked to psychological disorders in staff. Hence, we assessed the prevalence and associated factors of probable post-traumatic stress disorder (PTSD), anxiety, depression, and burnout of nursing home staff during the COVID-19 pandemic in a cross-sectional study including 66 randomly selected nursing homes in southern France. 537 of the contacted 3 821 nursing home workers (14.0%) responded between April and October 2021. We collected information on center organization, severity of COVID-19 exposure, and socio-demographic information in an online survey. The prevalence of probable PTSD (PCL-5), anxiety and depressive disorders (Hospital Anxiety Depression Scale) and the sub-scores of burnout syndrome (Maslach Burnout Inventory Human Services Survey for Medical Personnel) were assessed. Probable PTSD was reported in 115/537 responders (21.4% (95% CI [18.0%-24.9%])). After adjustment, low-level exposure to COVID-19 in nursing home residents (AOR, 0.5; 95% CI [0.3-0.9]), fear of managing COVID-19 residents (AOR, 3.5; 95% CI [1.9-6.4]), conflicts with residents (AOR, 2.3; 95% CI, [1.2-4.4]), conflicts with colleagues (AOR, 3.6; 95% CI [1.7-8.6]), cancellation of leave (AOR, 4.8; 95% CI [2.0-11.7]) and temporary worker employment (AOR, 3.4; 95% CI [1.7-6.9]) were associated with higher prevalence of probable PTSD. The prevalence of probable anxiety and depression were 28.8% (95% CI [24.9%-32.7%]) and 10.4% (95% CI [7.8%-13.1%]), respectively. Psychological disorders were observed in nearly one third of nursing home workers during the COVID-19 pandemic. Hence, continuous surveys and preventive measures are needed in this particularly at-risk population.

Motivation and Hesitancies in Obtaining the COVID-19 Vaccine-A Cross-Sectional Study in Norway, USA, UK, and Australia

BACKGROUND

Vaccinations protect the public against serious diseases or death; however, some individuals are hesitant in obtaining them. We aim to contribute to the understanding of the challenges of vaccination roll-out by examining the motivations, hesitancies, and their associated factors, in obtaining the COVID-19 vaccines two years into the pandemic.

METHODS

Cross-sectional online surveys were conducted in Norway, the USA, the UK, and Australia (N = 1649). The participants self-reported whether they had obtained one of the COVID-19 vaccines. Those who had obtained a vaccine reported the reason for their motivation, and those who had not obtained a vaccine reported the reason for their hesitancies.

RESULTS

More than 80% of the total sample obtained a COVID-19 vaccine because of public health recommendations and trusted that it was safe. Among those who had not obtained one, the most frequent reason was concerns about side effects. Most who obtained the vaccine reported that they believed in science, but many of those who had not obtained one reported distrust. Among those who had not obtained a vaccine, reports of distrust in policies and science were frequent. Concerns about side effects were more common in males and those with lower education, and those living in rural or remote areas.

CONCLUSION

People who endorsed the vaccine believed that the vaccine reduces the risk of illness, protects the health of others, and had trust in scientific vaccination research. Conversely, the most frequent reason for vaccine hesitancy was concerns about side effects, followed by distrust in healthcare and science. These findings could inform public health strategies that aim to increase vaccination rates.

How Midwestern College students protected their families in the first year of COVID-19

Introduction

College students routinely visit their families due to geographic proximity and their financial dependence. Consequently, the potential of transmitting COVID-19 from campus to their families' homes is consequential. Family members are key sources of support for one another in nearly all matters but there is little research uncovering the mechanisms by which families have protected each other in the pandemic.

Methods

Through an exploratory qualitative study, we examined the perspectives of a diverse, randomly sampled, group of students from a Midwestern University (pseudonym), in a college town, to identify COVID-19 prevention practices with their family members. We interviewed 33 students between the end of December 2020 and mid-April 2021 and conducted a thematic analysis through an iterative process.

Results

Students navigated major differences in opinions and undertook significant actions in attempts to protect their family members from COVID-19 exposure. Students' actions were rooted in the greater good of public health; prosocial behavior was on display.

Discussion

Larger public health initiatives could target the broader population by involving students as messengers.

Is Vaccine Hesitancy Affected by Distrust in the Healthcare System? A Study in Turkish Population

The aim of this study is to examine the effect of the perception of distrust in the healthcare system on vaccine hesitancy and to determine the association between the sociodemographic characters of the participants and their perception of distrust and their vaccine hesitancy. The population consisted of individuals who were 20 years old and above and were residing in Turkey. A total of 986 people participated in the study. The data were collected through a questionnaire that was prepared on Google Forms. As a result of the regression analysis, distrust in the healthcare system explained 20.7% of total variance in vaccine hesitancy and an increase in the perception of distrust in the healthcare system statistically increased the vaccine hesitancy. In the study, it was also determined that the participants' perceptions of distrust in the healthcare system caused statistically significant differences based on the variables of marital status, employment status, alcohol consumption, age, education level and income level. It was revealed that the participants' perceptions of vaccine hesitancy caused a statistically significant difference only based on age and the frequency of applying to the health institution.

Determinants of Covid-19 vaccination: Evidence from the US pulse survey

The Covid-19 disease is resurging across the United States and vaccine hesitancy remains a major obstacle to reaching the expected threshold for herd immunity. Using the nationally representative cross sectional Household Pulse Survey (HPS) Data published by the U.S. Census Bureau, this study identified demographic, socio-economic, and medical-psychological determinants of Covid-19 vaccination. Results revealed significant differences in Covid-19 vaccine uptake due to age, sex, sexual orientation, race or ethnicity, marital status, education, income, employment form, housing and living condition, physical illness, mental illness, Covid-19 illness, distrust of vaccines and beliefs about the efficacy of vaccines. Government policymakers need to be cognizant of these determinants of vaccine hesitancy when formulating policies to increase vaccine uptake and control the COVID-19 pandemic. The findings of this study suggest that segmented solutions to reach vulnerable groups like racial minorities and homeless people are needed to win the trust and optimize vaccine uptake.

Impact of the COVID-19 pandemic on cancer patients in western Pennsylvania: rural-urban disparities

PURPOSE

Disparities in cancer care persist between patients living in rural versus urban areas. The COVID-19 pandemic may have impacted concerns related to care and personal health differently in rural cancer patients. Using survey data collected from cancer patients in western Pennsylvania, we examined pandemic-related distress, concerns related to cancer care, impact on personal health, and the extent to which these differed by urban-rural residence.

METHODS

Patients filled out an initial survey in August-December 2020; a second survey was completed in March 2021. The following patient concerns related to the pandemic were evaluated: threat of COVID-19 to their health, pandemic-related distress, perceptions of cancer care, and vaccine hesitancy. Multivariable logistic regression models were used to examine relationships between these outcomes and urban-rural residence as well as patient-related factors, including anxiety symptoms and social support.

RESULTS

The study sample included 1,980 patients, 17% resided in rural areas. COVID-19 represented a major or catastrophic threat to personal health for 39.7% of rural and 49.0% of urban patients (p = 0.0017). Patients with high general anxiety were 10-times more likely to experience pandemic-related distress (p < 0.001). In the follow-up survey (n = 983), vaccine hesitancy was twice as prevalent among rural patients compared to urban (p = 0.012).

CONCLUSIONS

The extent to which perceptions of the threat of COVD-19 to personal health and vaccine hesitancy exacerbates rural-urban disparities in cancer care and prognosis warrants further study. Cancer patients may be vulnerable to heightened anxiety and distress triggered by the pandemic.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Spillover of Vaccine Hesitancy into Adult COVID-19 and Influenza: The Role of Race, Religion, and Political Affiliation in the United States

BACKGROUND

Due to its potential to lead to vaccine delays and refusals, vaccine hesitancy has attracted increased attention throughout the COVID-19 pandemic. It is crucial to investigate whether demographic patterns differ between adult general vaccine hesitancy and COVID-19 and flu vaccine non-receipt.

METHODS

A cross-sectional survey was conducted online in August 2022. In response to questions about vaccine hesitancy, participants indicated whether they would receive the vaccine given various safety and efficacy profiles. Through logistic regression models, we examined variations between general vaccine hesitancy and COVID-19 non-vaccination.

RESULTS

Among the 700 participants, 49% of the respondents were classified as having general vaccine hesitancy, 17% had not received the COVID-19 vaccine, and 36% had not had flu vaccinations. In the multivariable analysis, general vaccine hesitancy and the non-receipt of COVID-19 vaccines were significantly higher in Non-Hispanic Black participants, those with no religious affiliation, and Republicans and Independents.

CONCLUSIONS

Patterns of vaccine hesitancy and the non-receipt of the COVID-19 vaccination did not vary, indicating a substantial overlap and potential spillover in vaccine hesitancy over the course of the pandemic. Because changing people's opinions regarding vaccinations is generally a challenge, different interventions specific to demographic subgroups may be necessary.

The effect of altruism on COVID-19 vaccination rates

BACKGROUND

After the emergence of the first vaccines against the COVID-19, public health authorities have promoted mass vaccination in order to achieve herd immunity and reduce the effects of the disease. Vaccination rates have differed between countries, depending on supply (availability of resources) and demand (altruism and resistance to vaccination) factors.

METHODS

This work considers the hypothesis that individuals' health altruism has been an important factor to explain the different levels of vaccination between countries, using the number of transplants as a proxy for altruism. Taking European Union's countries to remove, as far as possible, supply factors that might affect vaccination, we carry out cross-sectional regressions for the most favorable date of the vaccination process (maximum vaccination speed) and for each month during the vaccination campaign.

RESULTS

Our findings confirm that altruism has affected vaccination rates against the COVID-19. We find a direct relationship between transplants rates (proxy variable) and vaccination rates during periods in which the decision to be vaccinated depended on the individual's choice, without supply restrictions. The results show that other demand factors have worked against vaccination: political polarization and belonging to the group of countries of the former Eastern bloc.

CONCLUSIONS

Altruism is a useful tool to define future vaccination strategies, since it favors the individuals' awareness for vaccination.

Vaccine Hesitancy in Mississippi: Does Political Ideology Muddy the Waters?

During the SARS-CoV2 pandemic vaccines were made available at a rapid pace in the United States (US) with support from the government. In Mississippi, vaccine hesitancy was marked. Across the country many areas of the US demonstrated reduced uptake regarding this specific vaccine due to a variety of reasons. Even with the efficacy of the vaccine indicative of a significant level of protection from mortality and serious morbidity, vaccine uptake and hesitancy were a significant concern. This study surveyed Mississippians on their willingness to take the vaccine or not, and in particular, investigated political ideology as a reason for vaccine hesitancy. Data was collected via an online survey and 589 adults (>18 years) responded. Those self-identifying as "Republican" were more than twice as likely to disagree that not getting the vaccine was a risk to their health and others (OR = 2.07, 95% CI 1.70, 2.54) as those who identified as "Democrat or independent" voters. Future health promotion efforts should specifically attempt to address this group in a more effective manner.

Mothers' Intention to Vaccinate Their Children Aged 5-11 Against COVID-19: A Cross-sectional Survey

Objectives

COVID-19 vaccines lower the risk of infection hospitalization, and death. Despite the safety and effectiveness of COVID-19 vaccines, some caregivers are hesitant to vaccinate their children against COVID-19. In this study, we explored the factors that influence Omani mothers' intentions to vaccinate their 5^-11 year-old children.

Methods

Of the 954 mothers approached, 700 (73.4%) participated in a cross-sectional face-to-face interviewer-administered questionnaire in Muscat, Oman, between 20 February and 13 March 2022. Data on age, income, level of education, trust in doctors, vaccine hesitancy, and intention to vaccinate their children were collected. Logistic regression was used to assess determinants of mothers' intention to vaccinate their children.

Results

Most mothers had 1-2 children (n = 525, 75.0%), had a college degree or higher education (73.0%), and were employed (70.8%). More than half (n = 392, 56.0%) reported that they were likely or very likely to get their children vaccinated. The intention to get children vaccinated was associated with older age (odds ratio (OR) = 1.05, 95% CI: 1.02-1.08; p =0.003), trust in their doctor (OR = 2.12, 95%, CI: 1.71-2.62; p < 0.001), and low vaccine hesitancy (OR = 25.91, 95% CI: 16.92-39.64; p < 0.001).

Conclusions

Understanding the factors that influence caregivers' intentions to vaccinate their children against COVID-19 is important for the development of evidence-based vaccine campaigns. To increase and sustain high vaccination rates for COVID-19 vaccination in children, it is critical to address the factors that cause caregiver hesitation about vaccines.

Public misperceptions of COVID-19 vaccine effectiveness and waning: experimental evidence from Ireland

OBJECTIVES

The study set out to measure public understanding of COVID-19 vaccine effectiveness (VE) and how effectiveness wanes with time since vaccination. Because perceived VE is a strong predictor of vaccine uptake, measuring perceptions can inform public health policy and communications.

STUDY DESIGN

Online randomised experiment.

METHODS

The study was undertaken in Ireland, which has high vaccination rates. A nationally representative sample (n = 2000) responded to a scenario designed to measure perceptions of COVID-19 VE against mortality. The length of time since vaccination in the scenario was randomly varied across four treatment arms (2 weeks, 3 months, 6 months, and 9 months).

RESULTS

The public underestimates VE, with substantial variation in perceptions. A majority (57%) gave responses implying perceived VE against mortality of 0-85%, i.e., below scientific estimates. Among this group, mean perceived VE was just 49%. Over a quarter (26%) gave responses implying perceived VE greater than 95%, i.e., above scientific estimates. Comparing the four treatment groups, responses took no account of vaccine waning. Perceived VE was actually higher 9 months after vaccination than 2 weeks after vaccination.

CONCLUSION

Despite high vaccination rates, most of the public in Ireland underestimates VE. Furthermore, the general public has not absorbed the concept of vaccine waning in the months following vaccination. Both misperceptions may reduce vaccine uptake, unless public health authorities act to correct them through improved communication.

Understanding coronavirus disease 2019 (COVID-19) vaccine hesitancy: Evidence from the community-driven knowledge site Quora

Objective

The present study aims to examine the threshold of coronavirus disease 2019 (COVID-19) vaccine hesitancy over time and public discourse around COVID-19 vaccination hesitancy.

Methods

We collected 3,952 questions and 66,820 answers regarding COVID-19 vaccination posted on the social question-and-answer website Quora between June 2020 and June 2021 and employed Word2Vec and Sentiment Analysis to analyze the data. To examine changes in the perceptions and hesitancy about the COVID-19 vaccine, we segmented the data into 25 bi-weekly sections.

Results

As positive sentiment about vaccination increased, the number of new vaccinations in the United States also increased until it reached a ceiling point. The vaccine hesitancy phase was identified by the decrease in positive sentiment from its highest peak. Words that occurred only when the positive answer rate peaked (e.g., safe, plan, best, able, help) helped explain factors associated with positive perceptions toward vaccines, and the words that occurred only when the negative answer rate peaked (e.g., early, variant, scientists, mutations, effectiveness) suggested factors associated with vaccine hesitancy. We also identified a period of vaccine resistance, where people who decided not to be vaccinated were unlikely to be vaccinated without further enforcement or incentive.

Conclusions

Findings suggest that vaccine hesitancy occurred because concerns about vaccine safety were high due to a perceived lack of scientific evidence and public trust in healthcare authorities has been seriously undermined. Considering that vaccine-related conspiracy theories and fake news prevailed in the absence of reliable information sources, restoring public trust in healthcare leaders will be critical for future vaccination efforts.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Knowledge and attitudes of pregnant women about Coronavirus vaccines in Turkiye

The aim of this cross-sectional study was to determine pregnant women's knowledge and attitudes regarding coronavirus vaccines in Turkiye. The research population consisted of 400 pregnant women who applied to a public hospital in this city. The data of the study was collected with the 'Personal Information Form' and 'Attitudes Towards COVID-19 Vaccine Scale'. Only 2% of the pregnant women stated that they wanted to receive coronavirus vaccines in their current pregnancy and 9.5% wanted it during the postpartum period. It has been concluded that the vast majority of pregnant women have insufficient knowledge and negative thoughts about coronavirus vaccines and the place where they live and their thoughts on the safety of coronavirus vaccines affect their positive attitudes about coronavirus vaccines.IMPACT STATEMENTWhat is already known on this subject? Many epidemics in history have been controlled or eliminated with vaccines. However, there is still insufficient evidence about the effects of coronavirus infection and vaccines on pregnant women.What do the results of this study add? As a result, it was found that the vast majority of pregnant women had insufficient knowledge and negative thoughts about coronavirus vaccines and very few of them wanted to receive the coronavirus vaccine during pregnancy and the postpartum period.What are the implications of these findings for clinical practice and/or further research? In the light of these findings, it is recommended that increase the vaccination rates in pregnant women by turning existing negative attitudes towards coronavirus vaccines in pregnant women into positive ones, providing accurate and effective information by health professionals and the media to eliminate negative attitudes caused by lack of information in pregnant women, conducting more studies on obstacles to increasing vaccine acceptance during pregnancy, and conducting studies on the subject with wider audiences and regions.

Prevalence and Factors Associated with Caregivers’ Hesitancy in Immunizing Dependent Older Adults with COVID-19 Vaccines: A Cross-Sectional Survey

Background: Coronavirus disease 2019 (COVID-19) vaccinations have been proven to prevent hospitalization and mortality. However, some caregivers may be hesitant to authorize COVID-19 vaccination of people under their care. Our study aimed to evaluate factors associated with caregiver hesitancy to authorize vaccination of dependent older adults. Method: We conducted a cross-sectional telephone survey of vaccine hesitancy among caregivers of dependent older patients in the geriatric clinic of Ramathibodi Hospital. Caregivers were contacted and interviewed by trained interviewers from 20 June to 25 July 2021. Results: The study enrolled 318 participants with a mean age of 55.9 years. The majority of the participants were the patients’ children (86.5%). In total, 39.9% of participants were hesitant to authorize COVID-19 vaccination of the older adults under their care. Factors associated with caregiver vaccine hesitation were uneasiness, anxiety, agitation, sadness, and worry in association with social distancing, refusal to receive a COVID-19 vaccine, and concern about vaccine manufacturers. Conclusion: The prevalence of caregiver hesitancy to allow older adults to undergo COVID-19 vaccination was relatively high, and several factors associated with this vaccine hesitancy were identified. These findings may aid efforts toward COVID-19 vaccination of dependent older adults.

Prevention and management of adverse events following COVID-19 vaccination using traditional Korean medicine: An online survey of public health doctors

BACKGROUND

Since February 2021, vaccination against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has started in Korea.

AIM

To perform a questionnaire survey about the prevention and management of adverse events of COVID-19 vaccination among public health doctors of Korean Medicine (PHKMDs).

METHODS

An online questionnaire was developed, comprising categories about adverse events of vaccination (AEVs) and perception of using Korean medicine (KM) in managing vaccine adverse events (AEs) among PHKMDs. PHKMDs’ experience of AEVs, usage of Korean medicine for AEVs, and perception and attitude in using KM for AEVs were surveyed. The survey web-link was emailed to the association of PHKMDs. Online links were sent through Survey Monkey to all PHKMDs in Korea.

RESULTS

A total of 143 participants were recruited for this study; 65% of participants were vaccinated at the same of the survey (n = 93). Although most participants did not take any medication for prevention of the adverse events, 62% (n = 58) of participants had taken herbal medicine to treat the adverse events (n = 52). Approximately 35% of participants (n = 33) said that they would recommend taking herbal medicine to prevent any AEVs. From various KM interventions, the participants strongly recommended taking an herbal medicine (n = 69, 74.19%) to treat AEs, and the second-highest was acupuncture treatment (n = 19, 20.43%).

CONCLUSION

Overall, this research demonstrated a high prevalence of KM usage by the PHKMDs. Hence, this study's results may serve as fundamental evidence for health professionals to consider using KM treatments when treating or preventing AEVs in the near future.

COVID-19 vaccination and mask wearing behaviors in the United States, August 2020 - June 2021

BACKGROUND

During the rollout of COVID-19 vaccination, many states relaxed mask wearing guidance for those vaccinated. The aim of this study was to examine the association between vaccination status and mask wearing behaviors.

METHODS

Seven waves of surveys (n = 6721) were conducted between August 2020 and June 2021. Participants were asked about initiation of COVID-19 vaccination and mask wearing behavior at work/school or a grocery store. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate associations between vaccination status and mask wearing at work/school and at the grocery store.

RESULTS

Between April and June 2021, mask wearing at work or school declined among both those vaccinated (74% to 49%) and unvaccinated (46% to 35%). There was a similar decline for mask wearing at grocery stores. The odds of wearing a mask were 2.35 times higher at work/school (95% CI: 1.82, 3.04) and 1.65 times at a grocery store (95% CI: 1.29, 2.11) among the vaccinated compared to unvaccinated.

CONCLUSION

Mask wearing decreased after mask guidelines were relaxed, with consistently lower mask wearing among the unvaccinated, indicating a reluctance among the unvaccinated to adopt COVID-19 risk reduction behaviors.

A systematic review to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated

The aim of this study was to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. In this study, data was obtained by retrospectively scanning the cross-sectional and qualitative studies published in the databases of 'PubMed, Cochrane, EBSCOhost, ULAKBİM and Google Scholar' in Turkish and English languages between 2011-2021. The PRISMA method was used in the preparation of the systematic review. In the studies reviewed, it was determined that the rate of pregnant women who were against the vaccine ranged from 6.2% to 98.6%, and the opinions of pregnant women against vaccination and the reasons for not getting vaccinated are presented under seven themes. The results of the study were considered important in terms of showing that quality and important studies were carried out in the literature on the subject and that the data were presented.IMPACT STATEMENTWhat is already known on this subject? Today, with the global coronavirus pandemic, vaccines and their effects are on the agenda again. Especially in pregnant women, opposition to vaccination and not getting vaccinated have emerged for various reasons.What do the results of this study add? The anti-vaccine thoughts of the pregnant women and the reasons for not getting vaccinated were mostly as follows: insufficient level of knowledge, mistrust of vaccines, perception of low infection risk, misconceptions and beliefs about the safety, content, side effects and efficacy of vaccines, worry and fear about the side effects of vaccines, the thought that the vaccine will harm herself and the baby, causes arising from healthcare professionals, financial, temporal and logistical barriers.What the implications are of these findings for clinical practice and/or further research? Scientific studies that can provide comprehensive and strong evidence about vaccine hesitancy and its causes, methods of increasing social approval in vaccination, and solutions should be proposed in the light of these researches in the fight against vaccine rejection.

Community-level characteristics of COVID-19 vaccine hesitancy in England: A nationwide cross-sectional study

One year after the start of the COVID-19 vaccination programme in England, more than 43 million people older than 12 years old had received at least a first dose. Nevertheless, geographical differences persist, and vaccine hesitancy is still a major public health concern; understanding its determinants is crucial to managing the COVID-19 pandemic and preparing for future ones. In this cross-sectional population-based study we used cumulative data on the first dose of vaccine received by 01-01-2022 at Middle Super Output Area level in England. We used Bayesian hierarchical spatial models and investigated if the geographical differences in vaccination uptake can be explained by a range of community-level characteristics covering socio-demographics, political view, COVID-19 health risk awareness and targeting of high risk groups and accessibility. Deprivation is the covariate most strongly associated with vaccine uptake (Odds Ratio 0.55, 95%CI 0.54-0.57; most versus least deprived areas). The most ethnically diverse areas have a 38% (95%CI 36-40%) lower odds of vaccine uptake compared with those least diverse. Areas with the highest proportion of population between 12 and 24 years old had lower odds of vaccination (0.87, 95%CI 0.85-0.89). Finally increase in vaccine accessibility is associated with COVID-19 vaccine coverage (OR 1.07, 95%CI 1.03-1.12). Our results suggest that one year after the start of the vaccination programme, there is still evidence of inequalities in uptake, affecting particularly minorities and marginalised groups. Strategies including prioritising active outreach across communities and removing practical barriers and factors that make vaccines less accessible are needed to level up the differences.

From a voluntary vaccination policy to mandatory vaccination against COVID-19 in cancer patients: an empirical and interdisciplinary study in bioethics

BACKGROUND

At the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.

METHODS

Between April and November 2021, the Ethics and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint (= quality of life/survival). We used a mainly qualitative methodological approach based on questionnaires and interviews.

RESULTS

In April 2021, 29 cancer patients refused or were reluctant to be vaccinated (5.6%; 29/522). Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal (1.9%; 10/522). One of the main reasons for the decrease in refusals was probably the introduction of the "pass sanitaire" (health pass) in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.

CONCLUSION

We identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between "the recommendation of anti-COVID-19 vaccination" (a new clinical practice) and "free will" (a moral value), and the duty to "protect each other" (a moral standard). Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life (i.e. happiness), or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished.

Attitudes toward Receiving COVID-19 Booster Dose in the Middle East and North Africa (MENA) Region: A Cross-Sectional Study of 3041 Fully Vaccinated Participants

COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal−Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.

Exploring Impacts to COVID-19 Herd Immunity Thresholds Under Demographic Heterogeneity that Lowers Vaccine Effectiveness

The COVID-19 pandemic has caused severe health, economic, and societal impacts across the globe. Although highly efficacious vaccines were developed at an unprecedented rate, the heterogeneity in vaccinated populations has reduced the ability to achieve herd immunity. Specifically, as of Spring 2022, the 0-4 year-old population is still unable to be vaccinated and vaccination rates across 5-11 year olds are low. Additionally, vaccine hesitancy for older populations has further stalled efforts to reach herd immunity thresholds. This heterogeneous vaccine landscape increases the challenge of anticipating disease spread in a population. We developed an age-structured Susceptible-Infectious-Recovered-type mathematical model to investigate the impacts of unvaccinated subpopulations on herd immunity. The model considers two types of undervaccination - age-related and behavior-related - by incorporating four age groups based on available FDA-approved vaccines. The model accounts for two different types of vaccines, mRNA (e.g., Pfizer, Moderna) and vector (e.g., Johnson and Johnson), as well as their effectiveness. Our goal is to analyze different scenarios to quantify which subpopulations and vaccine characteristics (e.g., rate or efficacy) most impact infection levels in the United States, using the state of New Mexico as an example.

Hesitancy towards the Third Dose of COVID-19 Vaccine among the Younger Generation in Japan

The younger generation's hesitancy towards the COVID-19 vaccine in Japan received significant attention during the early stages of vaccination. However, there is a lack of a comprehensive study in Japan that analyzes the apprehension towards the third dose of vaccine, commonly known as the booster dose, and its underlying causes. Using data from an online panel survey conducted by the Hiroshima Institute of Health Economics Research at Hiroshima University, we examined the severity of booster dose aversion among youths of different ages. Our findings indicate that a sizeable proportion of the Japanese population, particularly younger men, are hesitant to receive the booster dose. Furthermore, an inter-age group difference in booster dose aversion exists only among men. According to the probit regression results, subjective health status and future anxiety are associated with the booster vaccine hesitancy of men and women of various age groups. Moreover, few socioeconomic and behavioral factors like marital status, having children, household income and assets, and having a myopic view of the future, are also associated with the booster dose aversion among youths of certain ages. Given the diverse attitude of the younger generation, our findings suggest that public health authorities should develop effective communication strategies to reduce vaccine apprehension in the society.

The association between social media use and hesitancy toward COVID-19 vaccine booster shots in China: a web-based cross-sectional survey

COVID-19 vaccine booster shots are necessary to provide durable immunity and stronger protection against the emerging SARS-CoV-2 variants. As a major platform for access to information, social media plays an important role in disseminating health information. This study aimed to evaluate hesitancy toward COVID-19 vaccine booster shots in China, assess its association with social media use, and provide information to manage social media. We conducted a cross-sectional study across all 31 provinces in mainland China from November 12, 2021, to November 17, 2021. In total, 3,119 of 3,242 participants completed the questionnaire (response rate = 96.2%). COVID-19 vaccine booster shot hesitancy rate in China was 6.5% (95% CI: 5.6-7.3). Unemployment (adjusted odds ratio [aOR] 2.428, 95% CI: 1.590-3.670), low monthly income (aOR 2.854,95% CI: 1.561-5.281), low scores of knowledge (aOR 0.917, 95% CI: 0.869-0.968) and low level of cues to action (aOR 0.773, 95% CI: 0.689-0.869) were associated with vaccine hesitancy. Compared with public social media, lower vaccine hesitancy was associated with high perceived importance of social media (aOR 0.252, 95% CI: 0.146-0.445) and official social media use (aOR 0.671, 95% CI: 0.467-0.954), while higher vaccine hesitancy was associated with traditional media use (aOR 3.718, 95% CI: 1.282-10.273). More efforts are needed to regulate the content of social media and filtering out misinformation. The role of official social media in disseminating health information should be enhanced.

Vaccine hesitancy among communities in ten countries in Asia, Africa, and South America during the COVID-19 pandemic

Vaccine hesitancy is considered one of the greatest threats to the ongoing coronavirus disease 2019 (COVID-19) vaccination programs. Lack of trust in vaccine benefits, along with concerns about side effects of the newly developed COVID-19 vaccine, might significantly contribute to COVID-19 vaccine hesitancy. The objective of this study was to determine the level of vaccine hesitancy among communities in particular their belief in vaccination benefits and perceived risks of new vaccines. An online cross-sectional study was conducted in 10 countries in Asia, Africa, and South America from February to May 2021. Seven items from the WHO SAGE Vaccine Hesitancy Scale were used to measure a construct of belief in vaccination benefit, and one item measured perceived riskiness of new vaccines. A logistic regression was used to determine which sociodemographic factors were associated with both vaccine hesitancy constructs. A total of 1,832 respondents were included in the final analysis of which 36.2% (range 5.6-52.2%) and 77.6% (range 38.3-91.2%) of them were classified as vaccine hesitant in terms of beliefs in vaccination benefits and concerns about new vaccines, respectively. Respondents from Pakistan had the highest vaccine hesitancy while those from Chile had the lowest. Being females, Muslim, having a non-healthcare-related job and not receiving a flu vaccination during the past 12 months were associated with poor beliefs of vaccination benefits. Those who were living in rural areas, Muslim, and those who did not received a flu vaccination during the past 12 months had relatively higher beliefs that new vaccines are riskier. High prevalence of vaccine hesitancy in some countries during the COVID-19 pandemic might hamper COVID-19 vaccination programs worldwide. Programs should be developed to promote vaccination in those sociodemographic groups with relatively high vaccine hesitancy.

COVID-19 Vaccination Outcomes and Antibiotic Crisis and Overuse During the COVID-19 Pandemic in Bosnia and Herzegovina

Background

COVID-19 has different presentations from mild flu like symptoms such as anosmia, dysgeusia, fever, sore throat, cough, dyspnea, headache, abdominal pain and diarrhoea to severe COVID-19 with the development of acute respiratory syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, multiorgan failure or even death.

Objective

The aim of this research project was to present and highlight the outcomes of the vaccination against COVID-19 and the widespread use of antibiotics during the initial admission and treatment of COVID-19 patients in out of hospital settings.

Methods

This observational cross-sectional study was conducted between September 1st and September 24th 2021, during the fourth wave of COVID-19 outbreak in Bosnia and Herzegovina, among the patients admitted to the primary health care COVID-19 centre of Canton Sarajevo in Bosnia and Herzegovina.

Results

Patients were mostly female 213 (53.3%), with a mean age of 48.8±18.6, with hypertension 129 (32.3%) or diabetes mellitus 35 (8.7%) as comorbidities and being COVID-19 unvaccinated 236 (59.0%) COVID-19 unvaccinated patients expressed more fever (X 2=9.93, p<0.05), had typical COVID-19 chest X ray presentation (X 2=6.08, p<0.05) and abnormal lung auscultation sounds (X 2=5.43, p<0.05). Out of all patients, 312 (78.0%) have received antibiotics and 3 (0.75%) antivirotics such as favipiravir as therapy for the treatment of COVID-19. The mean duration of the antibiotic regime was 10.2 ± 7.5 days with a minimum of 3 days and maximum of 62 days. The minimum CRP value when antibiotics were prescribed was 0.1 (ref. value <5mg/l). The most prescribed antibiotic was doxycycline 172 (43.0%), followed by ceftriaxone 139 (34.7%) and azithromycin 108 (27.0%).

Conclusion

Our study showed that vaccination acts protective for the development of severe COVID-19 forms, as well as that antibiotics were overused among COVID-19 infected. The outcome of such malpractice could lead to antimicrobial resistance which will be seen in further years. Governmental agencies should advise physicians to change these trends.

COVID-19 Vaccine Hesitancy in Italy: Predictors of Acceptance, Fence Sitting and Refusal of the COVID-19 Vaccination

Background

The hesitancy in taking the COVID-19 vaccine is a global challenge. The need to identify predictors of COVID-19 vaccine reluctance is critical. Our objectives were to evaluate sociodemographic, psychological, and behavioral factors, as well as attitudes and beliefs that influence COVID-19 vaccination hesitancy in the general population of Italy.

Methods

A total of 2,015 people were assessed in two waves (March, April and May, 2021). Participants were divided into three groups: (1) individuals who accepted the vaccination (“accepters”); (2) individuals who refused the vaccination (“rejecters”); and (3) individuals who were uncertain about their attitudes toward the vaccination (“fence sitters”). Group comparisons were performed using ANOVA, the Kruskal-Wallis test and chi-square tests. The strength of the association between the groups and the participants' characteristics was analyzed using a series of multinomial logistic regression models with bootstrap internal validation (one for each factor).

Results

The “fence sitters” group, when compared to the others, included individuals of younger age, lower educational level, and worsening economic situation in the previous 3 months. After controlling for sociodemographic factors, the following features emerged as the main risk factors for being “fence sitters” (compared with vaccine “accepters”): reporting lower levels of protective behaviors, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and higher conspirative mentality. Higher levels of COVID-19 perceived risk, trust in institutions and informational sources, frequency of use of informational sources, agreement with restrictions and protective behaviors were associated with a higher likelihood of becoming “fence sitters” rather than vaccine “rejecters.”

Conclusions

The “fence sitters” profile revealed by this study is intriguing and should be the focus of public programmes aimed at improving adherence to the COVID-19 vaccination campaign.

Engaging Canadians in evidence-based communication about vaccines: a scoping review protocol of immunisation support programs in Canada

OBJECTIVE

To identify, characterise and map the existing knowledge about (1) immunisation programmes that provide evidence-based support about vaccines to Canadians and reduce barriers to vaccination; and (2) barriers and facilitators to the delivery of immunisation support programmes.

INTRODUCTION

Vaccine hesitancy is a complex issue that has significant repercussions for the health and safety of Canadians. Engaging in evidence-based communication about vaccines can reduce vaccine hesitancy and increase participation in immunisation programmes.

METHODS

The Joanna Briggs Institute methodology for scoping reviews will be used for this scoping review. A comprehensive keyword search strategy was developed and translated for six electronic databases on 19 November 2021: CINAHL via EBSCOhost, APA PsycINFO via EBSCOhost, Academic Search Complete via EBSCOhost, Scopus, Medline via EBSCOhost and EmCare via Ovid. We will identify unpublished literature by searching websites listed in CADTH's Grey Matters checklist and other relevant sources in January 2022. Two independent raters will screen and extract data from identified material. Data will be presented in a tabular form.

INCLUSION CRITERIA

We will consider Canadian programmes that target the general public and exclude papers targeting health professionals. Our review will not limit by vaccine type and will consider any intervention that aims to inform individuals about immunisation. Our primary concept involves mapping the characteristics of programmes (eg, programme description, delivery format) and our secondary concept will examine barriers and facilitators to programme delivery.

ETHICS AND DISSEMINATION

Ethical approval is not required as this study is a review of the published and publicly reported literature. Findings from this review will be disseminated to academic and health system stakeholders to inform immunisation programmes across a wide range of vaccine types and settings. We intend to use the results of this review to develop an immunisation support programme in Prince Edward Island, Canada.

COVID-19 Vaccination Behavior Among Frontline Healthcare Workers in Pakistan: The Theory of Planned Behavior, Perceived Susceptibility, and Anticipated Regret

Healthcare workers in Pakistan are still fighting at the frontline to control the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and have been identified as the earliest beneficiaries for COVID-19 vaccination by the health authorities of the country. Besides, the high vaccination rates of frontline healthcare workers (FHWs) are essential to overcome the ongoing pandemic and reduce the vaccines hesitancy among the general population. The current research employed the theory of planned behavior (TPB) to investigate the COVID-19 vaccination behavior among FHWs in Pakistan as well as the predictors of such behavior. Following the epidemic control and prevention policies, a sample of 680 FHWs were accessed to fill in the questionnaire evaluating the components of the TPB. Moreover, the potential role of anticipated regret (AR) and perceived susceptibility (PS) on COVID-19 vaccination behavior was also assessed. The partial least square structural equation modeling (PLS-SEM) results revealed that the TPB components, as well as the AR, have positive associations with the COVID-19 vaccination behavior. The results further confirmed that PS positively affects the anticipated regret, attitude (ATT), and subjective norm (SN) to vaccinate against SARS-CoV-2. The perceived susceptibility also has a positive association with COVID-19 vaccination behavior through the mediation of anticipated regret, ATT, and SN. Our findings highlighted the importance of COVID-19 vaccination among healthcare workers, which can be applied to reduce vaccine hesitancy among the general public.

Global diversity of policy, coverage, and demand of COVID-19 vaccines: a descriptive study

BACKGROUND

Hundreds of millions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered globally, but progress on vaccination varies considerably between countries. We aimed to provide an overall picture of COVID-19 vaccination campaigns, including policy, coverage, and demand of COVID-19 vaccines.

METHODS

We conducted a descriptive study of vaccination policy and doses administered data obtained from multiple public sources as of 8 February 2022. We used these data to develop coverage indicators and explore associations of vaccine coverage with socioeconomic and healthcare-related factors. We estimated vaccine demand as numbers of doses required to complete vaccination of countries' target populations according to their national immunization program policies.

RESULTS

Messenger RNA and adenovirus vectored vaccines were the most commonly used COVID-19 vaccines in high-income countries, while adenovirus vectored vaccines were the most widely used vaccines worldwide (180 countries). One hundred ninety-two countries have authorized vaccines for the general public, with 40.1% (77/192) targeting individuals over 12 years and 32.3% (62/192) targeting those ≥ 5 years. Forty-eight and 151 countries have started additional-dose and booster-dose vaccination programs, respectively. Globally, there have been 162.1 doses administered per 100 individuals in target populations, with marked inter-region and inter-country heterogeneity. Completed vaccination series coverage ranged from 0.1% to more than 95.0% of country target populations, and numbers of doses administered per 100 individuals in target populations ranged from 0.2 to 308.6. Doses administered per 100 individuals in whole populations correlated with healthcare access and quality index (R2 = 0.59), socio-demographic index (R2 = 0.52), and gross domestic product per capita (R2 = 0.61). At least 6.4 billion doses will be required to complete interim vaccination programs-3.3 billion for primary immunization and 3.1 billion for additional/booster programs. Globally, 0.53 and 0.74 doses per individual in target populations are needed for primary immunization and additional/booster dose programs, respectively.

CONCLUSIONS

There is wide country-level disparity and inequity in COVID-19 vaccines rollout, suggesting large gaps in immunity, especially in low-income countries.

The Effect of Message Framing on COVID-19 Vaccination Intentions among the Younger Age Population Groups: Results from an Experimental Study in the Italian Context

The coronavirus pandemic has been recognized as a major threat to public health. Widespread acceptance of COVID-19 vaccines is crucial for achieving adequate immunization coverage to end the global pandemic. However, to date, there are still hesitant people, especially among the younger population groups. For this reason, it is essential to identify the psychological variables that may affect vaccination intention among these “at risk groups” and to select possible successful communication frames in order to increase vaccination rates. An online cross-sectional survey was carried out on 208 Italian citizens younger than 50 years old, to explore message framing effects on their intention to receive the vaccination and to understand the psychological factors influencing it. Results showed that depending on the goal (stimulate vaccination intention, vaccination trust, or vaccine attitude), not all the communication stimuli are equally effective on this target population. Furthermore, the study showed that sociodemographic variables do not help to explain the vaccination intention of the younger population groups, while the psychological variables have been found to have a stronger impact on such attitude. Trust and attitudes towards vaccines, concern about the pandemic and concern about infecting others have been found to be the most effective predictive variables of people vaccination intention. The study results underline the importance of understanding the psychological roots behind vaccine hesitancy to shape sensitization actions and vaccination campaigns targeting this population group.

A Cross-Sectional Study of Knowledge, Attitudes, and Practices concerning COVID-19 Outbreaks in the General Population in Malang District, Indonesia

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, especially in a country such as Indonesia with its scarcity of health resources for testing and tracing. Using the case of Malang District, this study set out to evaluate KAP regarding COVID-19 and its risk factors immediately after the Malang health authorities implemented various preventive measures. A population-based survey involving 3425 individuals was carried out between 1 May and 20 May 2020. Our findings revealed that less than half of the respondents demonstrated accurate knowledge (25.3%), positive attitudes (36.6%), or frequent best practices (48.8%) with regard to COVID-19 prevention. The results of logistic regression analyses showed that more accurate knowledge was associated with more positive attitudes and more frequent best practices (OR = 1.603, p-value < 0.001; OR = 1.585, p-value < 0.001, respectively). More positive attitudes were also associated with more frequent best practices (OR = 1.126, p-value < 0.001). The level of KAP varied according to sociodemographic characteristics, access to the services of community health workers, and mobile health technology for COVID-19 screening. Some global health proposals to improve health behaviors among the general public in the context of the scarcity of health resource settings are suggested based on the study findings.

Willingness to Take the Booster Vaccine in a Nationally Representative Sample of Danes

We estimate the willingness to take the booster dose in a representative sample of Danes. We estimate an overall willingness in the adult Danish population of about 87 percent and a willingness of about 95.5 percent among primary vaccine takers. Moreover, we show that these percentages are significantly lower among younger populations, as well as among groups who do not see COVID-19 as a threat to society, those who do not feel that they have the ability to follow recommendations (‘self-efficacy’), those who do not perceive the advice of the health authorities as effective against disease spread (‘response efficacy’), and those who feel that the costs of following recommendations are high (‘response cost’).