COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Knowledge about, attitudes toward and acceptance and predictors of intention to receive the mpox vaccine among cancer patients in China: A cross-sectional survey

This study aimed to investigate the knowledge about, attitudes toward, and acceptance and predictors of receiving the mpox vaccine among Chinese cancer patients. Patients were selected using a convenience sampling method. A web-based self-report questionnaire was developed to assess cancer patients' knowledge, attitudes, and acceptance regarding the mpox vaccine. Multivariate logistic regression analysis was used to determine predictors of acceptance of the mpox vaccine. A total of 805 cancer patients were included in this study, with a vaccine hesitancy rate of 27.08%. Approximately 66% of the patients' information about mpox and the vaccine came from the mass media, and there was a significant bias in the hesitant group's knowledge about mpox and the vaccine. Multivariable logistic regression analysis suggested that retirement; chemotherapy; the belief that the mpox vaccine could prevent disease, that vaccination should be compulsory when appropriate and that the mpox vaccine prevents mpox and reduces complications; the willingness to pay for the mpox vaccine; the willingness to recommend that friends and family receive the mpox vaccine; and the belief that the mpox vaccine should be distributed fairly and equitably were factors that promoted vaccination. The belief that mpox worsens tumor prognosis was a driving factor for vaccine hesitancy. This study investigated the knowledge of cancer patients about mpox and the vaccine, evaluated the acceptance and hesitancy rates of the mpox vaccine and examined the predictors of vaccination intention. We suggest that the government scientifically promote the vaccine and develop policies such as free vaccination and personalized vaccination to increase the awareness and acceptance rate of the mpox vaccine.

The impact of risk perception and institutional trust on COVID-19 vaccine hesitancy in China

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

COVID-19 vaccine hesitancy among the Chinese elderly: A multi-stakeholder qualitative study

The United Nations reported that the mortality risk of Corona Virus Disease 2019 (COVID-19) is five times higher in the elderly than the global average. Although the COVID-19 vaccine effectively prevents infections and reduce mortality among the elderly, vaccine hesitancy among the Chinese elderly poses a significant threat. This study, utilizing the "Confidence, Convenience and Complacency (3 Cs)" vaccine hesitancy model, aimed to explore factors contributing to vaccine hesitancy among the Chinese elderly and assess national countermeasures and potential improvement approaches. Thirteen elderly with vaccine hesitancy and eleven vaccine-related staff participated in semi-structured interviews. Thematic analysis revealed three key determinants of vaccine hesitancy among the elderly: perceived low threat of COVID-19, lack of confidence in COVID-19 vaccine, and poor accessibility to vaccination. China has implemented strategies, including advocacy through diverse channels, joint multi-sectoral promotion vaccination, and enhancing ongoing vaccination services. Recommendations from the vaccine-related staff emphasize improving vaccine awareness among the elderly, and prioritizing the vaccination environment and process. The study underscores the importance of targeted vaccination promotion programs addressing hesitation reasons to improve vaccination rates. Furthermore, existing countermeasures can serve as a foundation for enhancing vaccination strategies, including improved publicity, administration, and management approaches.

Using cluster analysis to explore COVID-19 vaccine booster hesitancy by levels of medical mistrust in fully vaccinated US adults

BACKGROUND

Underlying causes of vaccine hesitancy could significantly affect successful uptake of the SARS-CoV2 vaccine booster doses during new waves of COVID-19. Booster rates among US adults are far below what is needed for immunity, but little is known about booster hesitancy among fully vaccinated adults and whether medical mistrust exacerbates barriers to uptake.

METHODS

A cross-sectional survey was completed among 119 adults in Philadelphia, PA who reported having received the primary SARS-CoV2 vaccine series but not a booster dose. Using the LaVeist Medical Mistrust (MM) Index, a k-means cluster analysis showed two clusters (Low MM, High MM) and differences in attitudes and perceptions about COVID-19 booster vaccines were assessed using F-tests.

RESULTS

Respondents were 62% Black and female; mean age was 41; 46% reported earning less than $25,000 and 53% had a high school education or less. Overall intention to get boosted was low (mean 3.3 on 0-10 scale). Differences in COVID-19 booster perceptions between those with High (n = 56) vs. Low (n = 59) MM were found, independent of any demographic differences. Most statements (7/10) related to reasons to not be boosted were significant, with those with High MM indicating more concern about feeling sick from the vaccine (F=-3.91, p≤ .001), beliefs that boosters are ineffective for vaccinated people (F= -3.46, p≤ .001), and long-term side effect worries (F=-4.34, p≤ .001). Those with High MM were also more concerned about the adverse effects of the vaccine (F=-2.48, p=.02), but were more likely to trust getting information from doctors or healthcare providers (F= -2.25, p=.03).

CONCLUSIONS

Results indicate that medical mistrust is an important independent construct when understanding current COVID-19 booster hesitancy. While much work has looked at demographic differences to explain vaccine hesitancy, these results suggest that further research into understanding and addressing medical mistrust could be important for implementing interventions to increase booster rates.

Perceived Effects of COVID-19 on Vaccine Hesitancy and Clinician Discussion: A Qualitative Study

BACKGROUND AND OBJECTIVES

Studies note a high prevalence of pediatric coronavirus disease 2019 (COVID-19)-specific vaccine hesitancy in the United States. Our objective was to assess whether clinicians perceive a spillover effect of COVID-19 vaccine hesitancy onto other vaccines, and the impact of this spillover on their general recommendation behavior.

METHODS

We conducted semistructured interviews with pediatricians in California and Colorado pediatric practices (January-March 2023). We transcribed, coded, and analyzed interviews using content analysis.

RESULTS

We interviewed 21 pediatricians (10 in California, 11 in Colorado). Clinicians observed some spillover effect of vaccine-favorable changes among some parents and greater hesitancy among others regarding the risks and benefits of childhood vaccination in general. This spillover was informed by 2 divergent patterns of parental trust in health systems and individual clinicians caused by the COVID-19 pandemic. Factors driving perceived changes included media coverage, greater knowledge about vaccination, and misinformation. Some clinicians felt that their approach to vaccine recommendations became more patient-centered, whereas others reported declining engagement in persuading hesitant parents about vaccination.

CONCLUSIONS

Clinicians described a hardening of parental views toward vaccines in both directions, which impacted their recommendation behavior. There is a need for vaccine hesitancy monitoring and better training and support for clinicians facing vaccine hesitant parents.

Maternal vaccination against COVID-19 and neonatal outcomes during Omicron: INTERCOVID-2022 study

BACKGROUND

In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality.

OBJECTIVE

This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern.

STUDY DESIGN

INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile.

RESULTS

We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns.

CONCLUSION

When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

Perceptions of COVID-19 Vaccination Among Organ Transplant Recipients

BACKGROUND

Understanding COVID-19 vaccine hesitancy in organ transplant recipients (OTRs) is critical given clear-albeit attenuated-benefits from vaccination.

METHODS

Adult OTRs were surveyed regarding sociodemographic data, medical history, and vaccine-related values. A novel outcome variable called the Vaccine Acceptance Composite Score (VACS) was built as the average Likert score of seven domains of vaccine confidence. To examine its association with several factors and individual adherence to COVID-19 vaccine recommendations, univariable odds ratios and relative operating characteristic areas under the curve (AUC) values were calculated.

RESULTS

Of 46 OTRs included, 32.6% identified as female, 13.3% as Black, and 6.77% as Hispanic or Latino/a/x. The median age was 58 years old. 93.5% of patients were kidney transplant recipients, and 63.0% previously had COVID-19. Patients were most concerned about COVID-19 vaccine-associated risks (46.3%), its potential effect on allograft (47.6%), and motives of government officials involved with vaccine policy (55.6%). Politically conservative patients were likelier to have lower VACS, whereas those who lived with someone ≥65 years old were likelier to have higher VACS. The VACS was not significantly associated with race, income, religious beliefs, comorbidities, COVID-19 history, or influenza vaccination status. Higher VACS was associated with ≥3 and ≥4 COVID-19 immunizations.

CONCLUSIONS

This study highlighted political beliefs and elderly household members as correlates of vaccine acceptance among OTRs. The VACS may be a useful tool to help standardize multifaceted analyses in vaccination-focused behavioral research. In clinical practice, it could help identify individuals and groups at risk for vaccine hesitancy, who may benefit from tailored outreach and educational interventions.

The impact of COVID-19 vaccination rate on traffic recovery

At the beginning of the COVID-19 pandemic in the US, traffic sharply fell due to social distancing policies in many locations. Correspondingly, many regions observed an increase in traffic volume (traffic recovery) as the pandemic eased in 2022. We examine how vaccination rates influence traffic recovery in Los Angeles County (LAC), controlling for differences in case counts, demographics, and socioeconomic factors across areas with different vaccination rates. We use arterial road sensor data as a proxy for the traffic volume within each ZIP code, alongside their respective demographic and socioeconomic characteristics. We find that a higher vaccination rate is statistically significantly associated with a larger traffic recovery, a finding that remains consistent across all explored models. This implies that an increased vaccination rate could reduce the public's perception of the risks of disease infection, leading to a larger traffic recovery. Moreover, we found that variables including population, income, race, work industry, and commuting preferences were correlated with vaccination rates. This highlights potential inequalities based on race, income, and industry sectors in the COVID-19 vaccination and a return to normal traffic flow.

Vaccine Hesitancy at Nine Community Sites Across the United States, Early in COVID-19 Vaccine Rollout

BACKGROUND

Vaccine hesitancy has been a significant concern throughout the COVID-19 pandemic. Vaccine hesitancy can be attributed to lack of confidence in vaccines, complacency about the health threat, or lack of convenience of vaccination. To date, few studies have used methods designed to include populations underrepresented in research when identifying factors associated with vaccine hesitancy.

METHODS

Between January and July 2021, potential participants were recruited from community venues selected through time-location sampling in 15 defined communities in the United States. Study staff administered a questionnaire on demographics, COVID-19 behaviors and attitudes, and vaccination status or intention to consenting individuals. Vaccine hesitancy was analyzed among those age 18 years and older from nine of the 15 sites and was defined as self-reported neutral, unlikely, or very unlikely vaccine intention. Logistic regression modeling, adjusted for site, identified factors associated with vaccine hesitancy.

RESULTS

Among 11,559 individuals, vaccine hesitancy by site ranged from 8.7 to 31.1%. Vaccine hesitancy was associated with being Black compared to White, being White compared to Asian, younger age, unstable housing, being unemployed, lower income, having a disability, providing care in home, not reporting inability to visit sick or elderly relatives during the pandemic, not reporting increased anxiety during the pandemic, and not spending more time with loved ones during the pandemic.

CONCLUSIONS

In these selected US communities, early in vaccine rollout, there were significant racial disparities in vaccine hesitancy. Additionally, individuals who were more marginalized due to their socioeconomic status were more likely to report vaccine hesitancy. Vaccine campaigns should make efforts to remove barriers to vaccination, by improving convenience.

COVID-19 vaccine uptake inequality among older adults: A multidimensional demographic analysis

BACKGROUND

Age, race, ethnicity, and sex are important determinants of coronavirus disease of 2019 (COVID-19) outcomes. Older adults (65 years and older) are at the highest risk of COVID-19 morbidity and mortality. Analyzing their vaccine uptake by subclassifying demographics is rare and can assist vaccination policies. This study investigates COVID-19 dose 1 and 2 vaccine uptakes among them by race, ethnicity, and sex.

METHODS

Immunization registry data were used to calculate temporal changes in older adults' COVID-19 vaccine uptake by race, ethnicity, race-sex, and ethnicity-sex in Kentucky's most populous county, Jefferson County, during the first 6 quarters of the COVID-19 vaccination program.

RESULTS

By May 2022, the county's Asian residents had the highest dose 1 and 2 vaccination rates (97.0% and 80.4%), then White residents (90.0% and 80.2%). Black residents had one of the lowest COVID-19 vaccination rates (87.3% and 77.3%). The rate among Hispanic residents (82.0% and 66.4%) was considerably lower than non-Hispanic residents (90.2% and 80.1%). The rates were consistently lower in males.

CONCLUSIONS

Racial, ethnic, and sex-based COVID-19 vaccine inequalities were largely maintained during the study period. Vaccine rollout practices and promotional programs should aim to boost the uptake of the COVID-19 vaccination among racial minority and male older adults.

Messaging Preferences about the COVID-19 Vaccine among Adults in Eastern North Carolina

Racially and ethnically diverse populations and individuals residing in rural areas were disproportionally impacted by the coronavirus pandemic, and Eastern North Carolina (ENC) is one region where such impacts were apparent. To understand at-risk individuals' perceptions and hesitancy to COVID-19 vaccines and the preferred means of receiving vaccination-related messages, we conducted four qualitative focus groups (N = 40) with diverse rural ENC residents. The analysis of the focus group transcripts revealed five themes: (1) reasons people trusted the COVID-19 vaccines, (2) reasons people mistrusted the COVID-19 vaccines, (3) the best means to deliver messages regarding COVID-19 vaccination, (4) the individuals trusted most to deliver such messages, and (5) the decisions people made regarding whether to get vaccinated and how that was connected to God. By incorporating participant perspectives and preferences in receiving messaging into campaigns, there is a potential for greater vaccine uptake.

Safety of Adjuvanted Recombinant Herpes Zoster Virus Vaccination in Fragile Populations: An Observational Real-Life Study

BACKGROUND

Vaccination is the most effective strategy for preventing infectious diseases and related complications, and proving its efficacy is crucial for its success and adherence, especially for newly introduced vaccines, such as adjuvanted recombinant herpes zoster virus vaccination (RZV). In this observational real-life study, we recorded adverse effects following immunization (AEFIs) after RZV administration in frail populations.

METHODS

A total of 271 subjects underwent RZV at Vaccination Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. Most subjects were solid organ transplant recipients (kidney, 77.1%; liver, 4.8%). Demographics, clinical data, and AEFIs (type, duration, and medications used) were recorded.

RESULTS

Overall, 37% of participants reported at least one AEFI following the first dose, predominantly pain at the injection site (60%), while 41% did so after the second dose (pain at the injection site in 62% of cases). Medications were more frequently used for AEFI treatment after the second dose (28%) rather than after the first dose (13%) (p = 0.01). After stratification by sex, females experienced AEFIs more frequently than males, particularly local skin reactions.

CONCLUSIONS

Our study added evidence of safety and tolerability of the adjuvanted recombinant RZV in frail adults.

Health Behaviors and Experiences of LGBTQ + Individuals during 2022 Mpox Outbreak: Findings from the QVax Study

The 2022 global outbreak of Mpox (formerly named Monkeypox) disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, with a significant impact on sexual minority men. A cross-sectional survey was conducted among LGBTQ + adults living in New Jersey and New York to examine vaccination behaviors for Mpox. We sought out to understand the health experiences and behaviors of the population during the initial outbreak. This analysis included a subset of participants (n = 253) who completed the survey after the onset of the Mpox outbreak in May 2022. We examined awareness of and concerns about Mpox, willingness to vaccinate, as well as vaccination access and vaccination uptake. Our findings indicate that white, cisgender, gay men, as well as employed individuals, had the highest rates of vaccination for Mpox. Those with higher levels of concern about the virus were both more likely to be vaccinated and to report difficulty securing an appointment. Overall, our findings reinforce the health disparities in the population, demonstrating as with many other health conditions that white and economically stable individuals have advantages in accessing care.

Identifying patterns and profiles of vaccination hesitancy among nurses for tailoring healthcare policies in the UK: A cross-sectional study

AIMS

To profile the characteristics of nurses with varying levels of vaccine hesitancy toward the COVID-19 and influenza vaccines.

BACKGROUND

In many countries across the world, healthcare workers, and nurses in particular, display significant reluctance toward COVID-19 and influenza vaccines due to concerns about safety, distrust in healthcare policies, and media influences. To address this, a proposed approach involves profiling nurses to tailor vaccination campaigns and to improve acceptance rates and public health outcomes.

METHODS

This cross-sectional study adopted the Vaccination Attitudes Examination scale to assess hesitancy toward COVID-19 and influenza vaccines among 294 registered nurses in the UK between March and July 2023. A K-means cluster analysis was performed. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were adopted.

RESULTS

Three profiles were identified. Profile A showed low vaccination hesitancy, profile B showed average hesitancy, and profile C showed high hesitancy toward vaccines. The highest concern for all profiles was related to unforeseen future effects of vaccination. Profile C had more nurses in early career roles, whereas nurses in profiles A and B were in more senior roles. Profile A showed higher educational attainment. Nurses in profile C used Snapchat more, whereas nurses in profile A used Twitter more frequently.

CONCLUSION

This study identified specific characteristics associated with higher levels of vaccination hesitancy in nursing. Unforeseen future effects of vaccination are a core aspect to consider in promoting vaccination.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Policies and vaccination campaigns should be targeted on early career nurses and should deliver tailored messages to dispel misinformation about unforeseen future effects of vaccination through specific social media platforms. Senior nurses should be involved as role models in promoting vaccination. These results are key for enhancing an evidence-based approach to implementing global health policies in healthcare.

Changes in vaccine hesitancy among parents of children aged 6 months - 17 Years, National Immunization Surveys, 2019-2022

BACKGROUND

Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States.

METHODS

Data from the 2019-2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months -17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5-11 years, and 12-17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points- before and after the authorization of the COVID-19 vaccine for each age group.

RESULTS

Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: -3.9, -0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5-11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12-17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups.

DISCUSSION

About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5-11 years and declined for children aged 6 months-4 years.

Gay and Bisexual Men's Perceptions about a Potential HIV Vaccine within a Post-COVID-19 Era: A Qualitative Study

To end the HIV epidemic, there is need for targeted strategies to reduce HIV incidence for those most vulnerable, including an HIV vaccine. This study seeks to understand the perceptions that non-PrEP using gay and bisexual men and other men who have sex with men (GBMSM) have about a potential HIV vaccine, while contextualizing their perspectives within the context of heightened vaccine hesitancy that has emerged since the COVID-19 pandemic. Between March and May of 2022, GBMSM (N = 20) participated in in-depth interviews, which assessed their perceptions about an HIV vaccine. Interviews were analysed using a codebook approach to thematic analysis. We oversampled for those unvaccinated against COVID-19 as a proxy for vaccine hesitation. Participants expressed a range of enthusiastic support, cautious optimism and skepticism when presented with the possibility of an HIV vaccine. Factors that drove willingness to receive an HIV vaccine included community-oriented altruism, individualized risk-benefit assessment, and/or the perception that a vaccine could provide a beneficial shift in sexual experiences. Participants also expressed hesitations about receiving an HIV vaccine, including concerns about potential side-effects and efficacy, as well as mistrust in the vaccine development process. Notably, participants often evaluated the vaccine in comparison to PrEP and condoms. Participants offered specific insights into information they would like to receive about an HIV and where/how they would like to receive it. Our findings can help inform future HIV vaccine implementation efforts by offering insights into the factors that motivate and deter GBMSM to receive an HIV vaccine.

COVID-19 Vaccine Hesitancy and Misinformation Endorsement among a Sample of Native Spanish-Speakers in the US: A Cross-Sectional Study

Research on COVID-19 vaccine hesitancy and misinformation endorsement among Spanish-speaking Americans is limited. This cross-sectional study used a Spanish-language survey from May-August 2021 among 483 Spanish speakers living in the US and Puerto Rico. We applied multivariable Poisson regression with robust error variances to assess the association between independent variables and binary outcomes for vaccine acceptance versus hesitance, as well as misinformation endorsement. Vaccine acceptance was associated with COVID-19 risk perception score (PR = 1.7 high vs. low perceived risk), opinion of government transparency (PR = 2.2 very transparent vs. not transparent), and trust in vaccine information (PR = 1.8 high vs. low). There was also an interaction between time spent on social media and social media as a main source of COVID-19 information (p = 0.0484). Misinformation endorsement was associated with opinion about government transparency (PR = 0.5 moderately vs. not transparent), trust in vaccine information (PR = 0.5 high vs. low trust), social media impact on vaccine confidence (PR = 2.1 decreased vs. increased confidence), distrust vaccines (PR = 1.9 distrust vs. trust), using vaccine information from Facebook (PR = 1.4 yes vs. no), and time spent on social media by those using social media as main source of COVID-19 vaccine information (p = 0.0120). Vaccine acceptance in respondents with high misinformation endorsement scores was 0.7 times those with low scores. These findings highlight the importance of effective information dissemination, the positive role of social media, and government transparency in boosting vaccine uptake among Spanish speakers in the US.

Measuring vaccination coverage and concerns of vaccine holdouts from web search logs

To design effective vaccine policies, policymakers need detailed data about who has been vaccinated, who is holding out, and why. However, existing data in the US are insufficient: reported vaccination rates are often delayed or not granular enough, and surveys of vaccine hesitancy are limited by high-level questions and self-report biases. Here we show how search engine logs and machine learning can help to fill these gaps, using anonymized Bing data from February to August 2021. First, we develop a vaccine intent classifier that accurately detects when a user is seeking the COVID-19 vaccine on Bing. Our classifier demonstrates strong agreement with CDC vaccination rates, while preceding CDC reporting by 1-2 weeks, and estimates more granular ZIP-level rates, revealing local heterogeneity in vaccine seeking. To study vaccine hesitancy, we use our classifier to identify two groups, vaccine early adopters and vaccine holdouts. We find that holdouts, compared to early adopters matched on covariates, are 67% likelier to click on untrusted news sites, and are much more concerned about vaccine requirements, development, and vaccine myths. Even within holdouts, clusters emerge with different concerns and openness to the vaccine. Finally, we explore the temporal dynamics of vaccine concerns and vaccine seeking, and find that key indicators predict when individuals convert from holding out to seeking the vaccine.

How Technology, Health Information Seeking, and Socioeconomic Factors Are Associated With Coronavirus Disease 2019 Vaccination Readiness in Estonians Over 50 Years?

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women

INTRODUCTION

The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine.

METHODS

We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis.

FINDINGS

The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making).

CONCLUSION

Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.

The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago

Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.

Benefit-Cost Analysis of the HHS COVID-19 Campaign: April 2021-March 2022

INTRODUCTION

This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts.

METHODS

Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024.

RESULTS

Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54.

CONCLUSIONS

The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.

Knowledge of the Serological Response to the Third BNT162b2 Vaccination May Influence Compliance of Healthcare Workers to Booster Dose

BACKGROUND

Previous studies showed that the fourth SARS-CoV-2 vaccine dose has a protective effect against infection, as well as against severe disease and death. This study aimed to examine whether knowledge of a high-level antibody after the third dose may reduce compliance to the fourth booster dose among healthcare workers (HCWs).

METHODS

We conducted a prospective cohort study among HCWs vaccinated with the first three doses at Rambam Healthcare Campus, a tertiary hospital in northern Israel. Participants underwent a serological test before the fourth booster vaccine was offered to all of them, with results provided to participants. The population was divided into two groups, namely those with antibodies below 955 AU/mL and those with 955 AU/mL and higher, a cutoff found protective in a previous study. Multiple logistic regression was carried out to compare the compliance to the fourth booster between the two groups, adjusted for demographic and clinical variables.

RESULTS

After adjusting for the confounding variables, the compliance was higher in those with antibody levels below 955 AU/mL (OR = 1.41, p = 0.05, 95% CI 1.10-1.96). In addition, male sex and age of 60 years and above were also associated with higher vaccination rates (OR = 2.28, p < 0.001, 95% CI 1.64-3.17), (OR = 1.14, p = 0.043, 95% CI 1.06-1.75), respectively.

CONCLUSIONS

Knowledge of the antibody status may affect compliance with the booster dose. Considering waning immunity over time, reduced compliance may affect the protection of HCWs who declined the fourth dose.

Evaluating Factors That Influence Influenza Vaccination Uptake among Pregnant People in a Medically Underserved Area in Washington State

INTRODUCTION

Despite substantial evidence demonstrating the effectiveness of influenza vaccines, only 38.6% of the adult United States population received an influenza vaccine during the 2023-2024 flu season. Vaccination rates are typically lower among U.S. minority groups, and in 2022, pregnant persons from U.S. minority racial and ethnic groups showed a decrease in influenza vaccine coverage.

METHODS

A survey was conducted with residents of Yakima County, Washington, which is home to one of the state's largest percentages of people who identify as Hispanic or Latino/a. The objective was to evaluate the uptake of influenza vaccine among pregnant persons. Surveys were sent to a random sample of 3000 residential mailing addresses. Of the 500 respondents, 244 (52.1%) reported that they had been pregnant, with those identifying as Hispanic or Latino/a constituting 23.8% of this total. Only 62 (26.2%) reported being immunized against influenza during pregnancy. Respondents who were immunized against influenza chose to be vaccinated to protect themselves from the flu (85.5%, n = 53); because a healthcare provider recommended getting vaccinated (85.5%, n = 53); to protect the baby from the flu (82.3%, n = 51); because it was available for free or low cost (62.9%, n = 39); and because vaccination was convenient (54.8%, n = 34). Qualitative evaluation identified that participants who were not vaccinated against influenza during pregnancy believed the vaccination was not needed, was not recommended by a healthcare provider, was difficult to access, they were against vaccination in general, or they were concerned about the safety and ingredients of the vaccine.

CONCLUSION

Barriers to vaccination identified in this study included vaccine distrust, lack of awareness, and concerns about vaccine efficacy and safety. Healthcare providers can help address these concerns by providing education and recommendations about the importance of influenza vaccination during pregnancy.

Understanding COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

The COVID-19 pandemic has presented the importance of vaccination as a pivotal strategy for controlling its spread. However, vaccine hesitancy poses a significant barrier to achieving widespread immunization in the United States. This systematic review utilizes the 5C model to examine the factors contributing to hesitancy, which include confidence in vaccines, complacency about disease risk, calculations of individual benefit, convenience of vaccination, and collective responsibility for the protection of others.

METHODS

We conducted a comprehensive search across several relevant databases and the gray literature, identifying 544 studies that used quantitative and qualitative methods to explore COVID-19 vaccine hesitancy in the general U.S.

POPULATION

RESULTS

This review identifies a complex interplay of factors affecting hesitancy, such as concerns over vaccine safety and efficacy, misinformation and conspiracy theories, demographic variables, and socioeconomic conditions. Key strategies for increasing vaccine uptake include transparent and effective communication along with proactive community engagement.

CONCLUSIONS

To effectively mitigate vaccine hesitancy, it is crucial to understand its multifaceted causes. Tailored interventions that consider socioeconomic and cultural contexts and prioritize clear communication, community involvement, and specific strategies to address unique concerns can enhance vaccine acceptance.

Social Determinants of Health and Satisfaction With Sources of Information About COVID-19 Related to Vaccine Uptake in a Safety Net Healthcare System

BACKGROUND

Vaccination is a critical tool to combat the COVID-19 pandemic. Yet, vaccine uptake varies across communities and is often affected by sociodemographic factors and accessibility.

OBJECTIVES

This article outlines a pilot study aimed to examine factors associated with COVID-19 patients within one of the nation's largest safety net healthcare systems.

METHODS

A cross-sectional survey design was conducted with adults over 18 years of age eligible to receive the COVID-19 vaccine. Descriptive analysis of survey data collected in 2021-2022 was employed. Unconditional and multivariate logistic regression analyses were conducted to examine associations between sociodemographics, social factors, and COVID-19 vaccine uptake.

RESULTS

Study participants ( N = 280) were a diverse patient population, primarily low-income and majority Hispanic/Latinx, with low education levels, but with a high level of COVID-19 vaccine uptake and a high rate of intent to vaccinate again. Approximately 22% report having unstable housing, and 46% experiencing food insecurity. Most trusted sources for COVID-19 data included mainstream media, including TV, radio, and newspapers, and friends, family, or other informal networks. We found that respondents who were satisfied or very satisfied with COVID-19 information received from healthcare providers or the government had higher odds of vaccine uptake rates.

DISCUSSION

These findings highlight the critical role of access to the COVID-19 vaccine and sources of information as an independent factor in COVID-19 vaccine uptake among patients within a safety net healthcare system. This study expands the literature on COVID-19 vaccine uptake, particularly in an underresourced region of the South Los Angeles community. Future research is needed to better understand the mechanisms between social determinants of health, perceived discrimination, and vaccine uptake.

Disparities in Influenza, Pneumococcal, COVID-19 Vaccine Coverage in High-Risk Adults Aged 19 to 64 Years in Southeastern Minnesota, 2010-2021

BACKGROUND

Despite effective vaccines against influenza, pneumococcus, and COVID-19, uptake has been suboptimal.

RESEARCH QUESTION

Although disparities in vaccination by race and ethnicity have been observed, what is the role of other sociodemographic factors in US vaccine uptake?

STUDY DESIGN AND METHODS

We conducted a population-based study using the Rochester Epidemiology Project (REP), a comprehensive medical records linkage system, to assess effects of sociodemographic factors including race, ethnicity, individual-level socioeconomic status (SES) via the housing-based socioeconomic status index, education, population density (urban or nonurban), and marital status with uptake of influenza, pneumococcal, and COVID-19 vaccination in high-risk adults. Adults at high risk of invasive pneumococcal disease residing in four counties in southeastern Minnesota who were aged 19 to 64 years were identified. Vaccination data were obtained from the Minnesota Immunization Information Connection and REP from January 1, 2010, through December 31, 2021.

RESULTS

We identified 45,755 residents. Most were White (82%), non-Hispanic (94%), married (56%), and living in an urban setting (81%), with three-quarters obtaining at least some college education (74%). Although 45.1% were up to date on pneumococcal vaccines, 60.1% had completed the primary COVID-19 series. For influenza and COVID-19, higher SES, living in an urban setting, older age, and higher education positively correlated with vaccination. Magnitude of differences in race, education, and SES widened with booster vaccines.

INTERPRETATION

This high-risk population is undervaccinated against preventable respiratory diseases, especially influenza and pneumococcus. Although national data reported improvement of disparities in COVID-19 vaccination uptake observed early in the pandemic, our data demonstrated gaps related to race, education level, SES, and age that widened with booster vaccines. Communities with high social vulnerabilities often show increased risk of severe disease outcomes, yet demonstrate lower uptake of preventive services. This highlights the need to understand better vaccine compliance and access in rural, lower SES, less-educated, Black, Hispanic, and younger populations, each of which were associated independently with decreased vaccination.

Reasons for COVID-19 Vaccine Hesitancy Among Patients Listed for Solid Organ Transplants

BACKGROUND

Patients listed for solid organ transplants (LSOTP) are at high risk for severe COVID-19 outcomes. Despite national guidelines recommending COVID-19 vaccination for LSOTP, vaccine hesitancy and underuse are reported in this population; however, reasons for this finding have not been examined thoroughly.

METHODS

This single-center retrospective survey analysis aimed to characterize reasons for COVID-19 vaccine hesitancy among 110 heart, liver, and kidney patients LSOTP who had not received all the recommended vaccine doses at the time of the study. Survey questions also investigated experiences with influenza vaccination.

RESULTS

Fifty-four patients (49.1%) responded to the telephone survey. The most common reasons for vaccine hesitancy were perceived lack of research in vaccine development (31%), fear of vaccine-related side effects (22%), and belief that the vaccine was unnecessary (20%). Of the respondents, 35% reported changing their vaccine perception after being listed for a transplant, most commonly attributing this to a perception that the COVID-19 vaccine is not safe for transplant recipients (32%). Gender differences in hesitancy reasons were observed, with males more likely to delay vaccination until after transplantation, although this difference was not significant (P = .07). Despite these findings, 54% of all respondents reported receiving annual influenza vaccines consistently.

CONCLUSION

Despite their risk, patients LSOTP show significant hesitancy toward COVID-19 vaccines owing to perceived safety and necessity issues. The results of this study can inform targeted educational efforts to address and rectify misconceptions and concerns about COVID-19 vaccination among patients LSOTP. Future studies focused on larger, more diverse cohorts are needed to expand our understanding of and address vaccination hesitancy among this vulnerable patient population.

SARS-CoV-2 Vaccination Rates and Uptake of Tixagevimab-Cilgavimab Among a Cohort of Pediatric Solid Organ Transplant Recipients

INTRODUCTION

There is a lack of data regarding SARS-CoV-2 vaccination rates and tixagevimab-cilgavimab (TC) uptake among pediatric solid organ transplant recipients. The purpose of our study was to assess these rates.

MATERIALS AND METHODS

We reviewed vaccination records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN, who received a transplant between January 2011 and December 2021. All SARS-CoV-2 vaccines and doses of TC received on or before September 1, 2022, the date of approval of the bivalent SARS-CoV2 vaccine, were included. We also assessed whether patients had been seen by an infectious diseases physician (ID) in the preceding 6 months.

RESULTS

Our study included 110 patients: 47 kidney, 36 heart, and 27 liver transplant recipients. All vaccine doses recorded were monovalent SARS-CoV-2 vaccines. Sixty-eight (61.8%) patients received at least one vaccine. This varied by age group, with f of ≥12 years olds, 40.9% of 5-11 year olds and 14.3% of under 5 year olds (p = 0.001). Seven patients (6.4%) were up-to-date (UTD) for age. There was no difference in UTD status by organ type (p = 0.335). Patients who saw ID were significantly more likely to be UTD (13.2% versus 2.8%; p = 0.047). Among those eligible, 14 (18.2%) received TC, with rates not different based on transplanted organ type (p = 0.158) or whether they saw ID (p = 0.273).

CONCLUSIONS

Despite the availability of vaccines, nearly 40% of pediatric solid organ transplant recipients remained unvaccinated against SARS-CoV-2 at time of the bivalent vaccine release. Less than a fifth of eligible patients received TC. Strategies to increase uptake of SARS-CoV-2 vaccines as well as adjunctive agents among this vulnerable group should be further explored.

The role of hesitancy and infrastructure in the equity and efficiency of COVID-19 vaccine administration

After the first COVID-19 vaccines received emergency use authorization from the U.S. FDA in December 2020, U.S. states employed vaccine eligibility and administration plans (VEAPs) that determined when subgroups of residents would become eligible to receive the vaccine while the vaccine supply was still limited. During the implementation of these plans, public concern grew over whether the VEAPs and vaccine allocations from the federal government were resulting in an equitable and efficient vaccine distribution. In this study, we collected data on five states' VEAPs, federal vaccine allocations, vaccine administration, and vaccine hesitancy to assess the equity of vaccine access and vaccine administration efficiency that manifested during the campaign. Our results suggest that residents in states which opened eligibility to the vaccine sooner had more competition among residents to receive the vaccine than occurred in other states. Regardless of states' VEAPs, there was a consistent inefficiency in vaccine administration among all five states that could be attributed to both state and federal infrastructure deficits. A closer examination revealed a misalignment between federal vaccine allocations and the total eligible population in the states throughout the campaign, even when accounting for hesitancy. We conclude that in order to maximize the efficiency of future mass-vaccination campaigns, the federal and state governments should design adaptable allocation policies and eligibility plans that better match the true, real-time supply and demand for vaccines by accounting for vaccine hesitancy and manufacturing capacity. Further, we discuss the challenges of implementing such strategies.

Examining the role of knowledge and trust on vaccine confidence in North Dakota among university students, faculty, and staff

BACKGROUND

Vaccination is one of the greatest tools for individuals to stay healthy. Individuals are, however, often exposed to misinformation via digital and social media, and thus, may miss the opportunity to develop scientific knowledge about vaccines and trust in relevant stakeholders. This has a damaging impact on vaccine confidence. Understanding vaccine confidence is particularly important in North Dakota, where vaccination rates are lower than national averages.

OBJECTIVES

The objectives of this research are to examine the association between vaccine confidence and three potential sources of it, namely, trust, vaccine knowledge, and vaccine information sources and to investigate the relative strength of three vaccine confidence sources, while accounting for covariates.

METHODS

Students (n = 517, 56.6%) and staff and faculty (n = 397, 43.4%) at the University of North Dakota (n = 914) completed an online survey. Logistic regressions estimated odds ratios (OR) and 95% confidence intervals (CI) for associations among trust in doctors, family/friends, government health agencies, charitable organizations, and religious organizations, vaccine knowledge, vaccine information sources as well as vaccine confidence, accounting for gender, race, marital status, age, religion, political ideology, education, and health status.

RESULTS

The mean age of participants was 29.43 years (SD = 13.48). Most were females (71.6%) and white (91.5%). Great trust in doctors (OR = 3.29, p < 0.001, 95%CI 1.89, 5.73) government health agencies (OR = 2.95, p < 0.001, 95%CI 2.13, 4.08) and vaccine knowledge (OR = 1.28, p < 0.001, 95%CI 1.18, 1.38) had higher odds of vaccine confidence. Using Internet Government source as the primary source of vaccine information (OR = 1.73, p < 0.05, 95%CI 1.22, 2.44) showed higher odds of vaccine confidence before all independent variables were introduced, but it became non-significant after they were introduced. Trust in government health agencies showed strongest associations with vaccine confidence.

CONCLUSION

Multiple stakeholders are necessary to ensure verified, accessible, and accurate information in order to advance vaccine confidence in rural, conservative areas.

Infection Prevention and Control Implications of Special Pathogens in Children

Special pathogens are broadly defined as highly transmissible organisms capable of causing severe disease in humans. Children's hospital healthcare personnel (HCP) should be prepared to identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key infection prevention, clinical, and public health stakeholders. Effective preparedness requires resources and practice with attention to education, policies and procedures, drills and training, and supplies. Successfully preparing for special pathogens is an important measure toward keeping communities, HCP, and patients and families safe in this global age that brings pathogens from across the world to our doorstep.

A qualitative study evaluating COVID-19 vaccine hesitancy among individuals living in Mississippi

Background

COVID-19 vaccination rates are lower in the Southern United States compared to other regions. This study investigated COVID-19 vaccination hesitancy in Mississippi (MS) to identify preferences that may boost MS vaccination strategies in areas with poor vaccine uptake.

Methods

Qualitative interviews were completed between April 2021 and January 2022 with staff and patients at four Federally Qualified Health Centers in MS. Interviews included the following COVID-19 vaccine topics: willingness to be vaccinated, barriers and facilitators, and methods for providing vaccine information. Data were organized with NVivo software and analyzed using reflexive thematic analysis.

Results

Fifteen clinic staff and 49 patients were interviewed. Barriers to vaccine uptake included a lack of knowledge and understanding of how the vaccine worked, distrust of the government, fear of side effects, and social pressure to stay unvaccinated. Vaccination facilitators included its widespread accessibility, a desire to protect themselves and vulnerable populations, and a previous unpleasant COVID-19 illness experience. Participants stated that vaccine information should be provided by health organizations and familiar, respected community members.

Conclusions

Results identified barriers to vaccination, such as mistrust of the government and healthcare system, and facilitators like vaccination advocacy originating from congregations and religious leaders. These findings can inform future COVID-19 vaccination efforts to increase overall immunization rates in MS. Future research in other locations could further assess commonalities and differences in the barriers and facilitators to vaccination.

COVID-19 ethics: unique aspects and a review as of early 2024

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.

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

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

Reasons for COVID-19 Non-Vaccination from 2021 to 2023 for Adults, Adolescents, and Children

Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau's Household Pulse Survey collected from January 2021 to May 2023, we assessed reasons for the non-vaccination of adults, adolescents, and children using the Health Belief Model as the framework for understanding behavior. Among unvaccinated adults, perceived vulnerability increased from 11.9% to 44.1%, attitudinal factors/mistrust increased from 28.6% to 53.4%, and lack of cue to action increased from 7.5% to 9.7% from January 2021 to May 2022. On the other hand, safety/efficacy concerns decreased from 74.0% to 60.9%, and logistical barriers to vaccination decreased from 9.1% to 3.4% during the same time period. Regarding reasons for non-vaccination of youth, perceived vulnerability increased from 32.8% to 40.0%, safety/efficacy concerns decreased from 73.9% to 60.4%, and lack of cue to action increased from 10.4% to 13.4% between September 2021 and May 2023. While safety/efficacy concerns and logistic barriers have decreased, increases in perceived vulnerability to COVID-19, mistrust, and lack of cues to action suggest that more efforts are needed to address these barriers to vaccination.

Healthcare workers' attitudes toward and factors influencing their acceptance of an annual COVID-19 booster vaccine: a cross-sectional study in Palestine

BACKGROUND

The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine if recommended and its association with their attitudes and burnout levels.

METHODS

We used an online self-administered questionnaire to conduct a cross-sectional study of all HCWs in the West Bank and Gaza Strip of Palestine between August and September 2022. We used the Vaccination Attitudes Examination scale to assess HCWs' vaccination attitudes and the Maslach Burnout Inventory to assess work-related Burnout. In addition, we conducted logistic regression to identify factors independently associated with the acceptance of the booster vaccine.

RESULTS

The study included 919 HCWs; 52.4% were male, 46.5% were physicians, 30.0% were nurses, and 63.1% worked in hospitals. One-third of HCWs (95% CI: 30.5%-36.7%) said they would accept an annual COVID-19 booster vaccine if recommended. HCWs who are suspicious of vaccine benefits [aOR = .70; 95%CI: .65-.75] and those concerned about unforeseeable future effects [aOR = .90; 95%CI: .84-.95] are less likely to accept the booster vaccine if recommended, whereas those who receive annual influenza vaccine are more likely to get it [aOR = 2.9; 95%CI: 1.7-5.0].

CONCLUSION

Only about a third of HCWs would agree to receive an annual COVID-19 booster vaccine if recommended. Mistrust of the vaccine's efficacy and concerns about side effects continue to drive COVID-19 vaccine reluctance. Health officials need to address HCWs' concerns to increase their acceptance of the annual vaccine if it is to be recommended.

Social and Structural Determinants of Health Associated with COVID-19 Vaccine Hesitancy among Older Adults in the United States

State-level COVID-19 vaccination rates among older adults have been uneven in the United States. Due to the immunocompromised nature of older adults, vaccine hesitancy increases the risk of morbidity and mortality. This study aims to determine the association between the social determinants of health, the structural determinants of health, and COVID-19 vaccine hesitancy among older adults in the United States. Secondary data from the Health and Retirement Study (HRS) dataset were used. A descriptive analysis and multinomial multivariable logistic regression were performed to examine the association of the independent variables-gender, age, race, immigration status, marital status, broadband internet access, social security income, Medicare coverage, education, and frequency of religious service-with the dependent variable, vaccine hesitancy. Compared to the respondents with no vaccine hesitancy and without the specific predictor, the respondents who reported religious attendance at least once/week were more likely to be "somewhat hesitant", divorced respondents had higher odds of being "somewhat hesitant", and older adults aged 65-74 years were more likely to be "very hesitant" or "somewhat hesitant" about the COVID-19 vaccine. Compared to the respondents with no vaccine hesitancy and without the specific predictor, females had higher odds of being "very hesitant", "somewhat hesitant", or a "little hesitant", and African Americans were more likely to be "very hesitant", "somewhat hesitant", or a "little hesitant" about the COVID-19 vaccine. Addressing these factors may limit the barriers to vaccine uptake reported among older adults and improve herd immunity among the immunocompromised population.

Association between COVID-19 Booster Vaccination and COVID-19 Outcomes among U.S. Adults

Understanding the association between booster vaccination and COVID-19 outcomes can help strengthen post-pandemic messaging and strategies to increase vaccination and reduce severe and long-term consequences of COVID-19. Using the Household Pulse Survey data collected from U.S. adults from 9 December 2022 to 13 February 2023 (n = 214,768), this study assessed the relationship between COVID-19 booster vaccination and COVID-19 outcomes (testing positive for COVID-19, moderate/severe COVID-19, and long COVID). Disparities were found in COVID-19 outcomes (e.g., testing positive for COVID-19, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics, region of residence, food insecurity status, mental health status, disability status, and housing type. Receipt of a COVID-19 booster vaccination was negatively associated with testing positive for COVID-19 (aOR = 0.75, 95%CI: 0.72,0.79), having moderate/severe COVID-19 (aOR = 0.92, 95%CI: 0.88, 0.97), or having long COVID (aOR = 0.86 (0.80, 0.91)). Even among those who tested positive for COVID-19, those who received the booster vaccine were less likely to have moderate/severe COVID-19 and less likely to have long COVID. Communicating the benefits of COVID-19 booster vaccination, integrating vaccination in patient visits, and reducing access barriers can increase vaccination uptake and confidence for all individuals and protect them against the severe negative outcomes of COVID-19.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

The role of trust, vaccine information exposure, and Health Belief Model variables in COVID-19 vaccination intentions: Evidence from an HBCU sample

African Americans have been disproportionately affected by COVID-19 and COVID-19 vaccines were initially met with hesitancy from the African American community. This study identified predictors of COVID-19 vaccination intentions among students attending a Historically Black College and University (HBCU) when COVID-19 vaccines first became available. Unvaccinated students (N = 224) completed a survey. Path analysis modeled relationships among exogenous variables (trust, exposure to pro- and anti-vaccine information), proposed mediators (Health Belief Model variables), and COVID-19 vaccination intentions. Students reported low trust in government officials, medical professionals, and the vaccine development process. Direct predictors of vaccination intentions included trust, perceived benefits, and perceived barriers. Students with lower trust reported lower benefits, increased concerns about side effects, and were more likely to view COVID-19 vaccination as low priority, and these factors in turn predicted intentions. Findings highlight the urgent need for theory-driven, culturally sensitive, age-relevant messaging to reduce vaccine hesitancy among Black young adults.

The impact of COVID-19 vaccine reactions on secondary vaccine hesitancy

BACKGROUND

Primary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy.

OBJECTIVE

To evaluate self-reported allergic and skin vaccine reactions as factors potentially associated with vaccine hesitancy in a nationwide vaccine allergy registry.

METHODS

Responses to survey questions concerning COVID-19 vaccine perceptions, coded from free text by 2 independent reviewers. Multivariable logistic regression models were used to determine the association between changed negative perception and respondent demographics, vaccination history, and reaction characteristics.

RESULTS

A total of 993 individuals (median of 46 years [IQR, 36-59], 88% female, 82% White) self-reported reactions to COVID-19 vaccination. Reactions included the following: delayed large local skin reaction (40%), hives/urticaria (32%), immediate large local skin reaction (3%), swelling (3%), anaphylaxis (2%), and other or unspecified (20%). Most respondents were initially unconcerned about the safety of COVID-19 vaccines (56%). After reactions, 401 of 993 (40%) report negative change in perception of vaccination, with more than half of these respondents (n = 211, 53%) citing their reasoning as a negative experience with adverse effects. Of 102 individuals asked about future vaccination, 79 (77%) indicated that they were unlikely or very unlikely to receive future COVID-19 vaccinations. Increased negative perception after reaction was associated with younger age, later COVID-19 vaccination dose number, and reaction type.

CONCLUSION

Our findings reveal that an individual's experience with allergic or cutaneous adverse effects after COVID-19 vaccination affects attitudes and decision-making regarding future vaccination, even in initially non-hesitant individuals. Further investigation of secondary vaccine hesitancy is necessary for adapting public health messaging to this important population.

Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children

IMPORTANCE

Healthcare personnel (HCP) are important messengers for promoting vaccines, for both adults and children. Our investigation describes perceptions of fully vaccinated HCP about COVID-19 vaccine for themselves and primary series for their children.

OBJECTIVE

To determine associations between sociodemographic, employment characteristics and perceptions of COVID-19 vaccines among HCP overall and the subset of HCP with children, who were all mandated to receive a COVID-19 vaccine, in a large US metropolitan region.

DESIGN

Cross-sectional survey of fully vaccinated HCP from a large integrated health system.

SETTING

Participants were electronically enrolled within a multi-site NYS healthcare system from December 21, 2021, to January 21, 2022.

PARTICIPANTS

Of 78,000 employees, approximately one-third accessed promotional emails; 6,537 employees started surveys and 4165 completed them. Immunocompromised HCP (self-reported) were excluded.

EXPOSURE(S) (FOR OBSERVATIONAL STUDIES)

We conducted a survey with measures including demographic variables, employment history, booster status, child vaccination status; vaccine recommendation, confidence, and knowledge.

MAIN OUTCOME(S) AND MEASURES

The primary outcome was COVID-19 vaccine hesitancy for all dose types - primary series or booster doses - among HCP.

RESULTS

Findings from 4,165 completed surveys indicated that almost 17.2 % of all HCP, including administrative and clinical staff, were hesitant or unsure about receiving a COVID-19 vaccine booster, despite the NYS recommendation to do so. Depending on age group, between 20 % and 40 % of HCP were hesitant about having their children vaccinated for COVID-19, regardless of clinical versus non-clinical duties. In multivariable regression analyses, lack of booster dose, unvaccinated children, females, income less than $50,000, and residence in Manhattan remained significantly associated with vaccine hesitancy.

CONCLUSIONS AND RELEVANCE

Despite mandated COVID-19 vaccination, a substantial proportion of HCP remained vaccine hesitant towards adult booster doses and pediatric COVID-19 vaccination. While provider recommendation has been the mainstay of combatting COVID-19 vaccine hesitancy, a gap exists between HCP-despite clinical or administrative status-and the ability to communicate the need for vaccination in a healthcare setting. While previous studies describe the HCP vaccine mandate as a positive force to overcome vaccine hesitancy, we have found that despite a mandate, there is still substantial COVID-19 vaccine hesitancy, misinformation, and reluctance to vaccinate children.

Prenatal Vaccination Patterns among Birthing Individuals with History of Preterm Birth in the Pre- and Post-COVID Era

OBJECTIVE

This study aims to explore vaccination acceptance among individuals with a history of preterm birth between March and June during the pre-COVID (2019), early-COVID (2020), and late-COVID (2021) periods.

STUDY DESIGN

This is a cross-sectional, retrospective cohort study of pregnant individuals with a history of preterm birth (<37 weeks' gestation) who initiated care of a subsequent pregnancy during pre-COVID (March-June 2019), early-COVID (March-June 2020), or late-COVID (March-June 2021). The primary outcome of interest was vaccination status for influenza, Tdap, and COVID-19 vaccines. Fisher's exact and chi-square tests were used to investigate association between vaccination status and time periods, race/ethnicity, and insurance.

RESULTS

Among 293 pregnancies, influenza vaccination rate was highest in early-COVID (p < 0.05). There was no statistically significant difference in Tdap or COVID-19 vaccination between time periods. COVID-19 vaccination was highest in individuals with private insurance (p < 0.05). There was no statistically significant difference in vaccination status by race/ethnicity.

CONCLUSION

In this study on high-risk pregnant individuals, the majority of our cohort remained unvaccinated against COVID-19 into the late-COVID period. Additionally, their influenza vaccination rates were greater than the national average in early-COVID and substantially lower than the national average in late-COVID. This shift in influenza vaccination acceptance may have been sparked by COVID-19 vaccine distribution beginning in January 2021 leading to overall vaccination hesitancy. Standardized guidelines and counseling concerning prenatal safety in recommended immunizations may serve as important tools of reassurance and health promotion.

KEY POINTS

· Maternal infections during pregnancy are a risk factor for preterm birth.. · High-risk cohort had low influenza vaccination post-COVID possibly due to COVID-19 vaccine hesitancy.. · Vaccination education may be a uniquely important tool among high-risk pregnant patients..

COVID-19 Vaccine Acceptance in Pregnant Women in the United States: A Systematic Review and Meta-Analysis

Purpose: Pregnant women are vulnerable to Coronavirus Disease 2019 (COVID-19) complications, yet may hesitate to get vaccinated. It is important to identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy. Methods: We searched PubMed, Embase, and Web of Science for articles published through January 2023 for keywords/terms related to immunization, COVID-19, and pregnancy, and performed a systematic review and meta-analysis to examine characteristics associated with vaccine acceptance. Results: Of 1,592 articles, 23 met inclusion criteria (focused on pregnant women in the United States, and their willingness or hesitation to vaccinate). Twenty-two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. Meta-analyses demonstrated that compared with Whites, Hispanics (odds ratios [OR] 0.72; 95% confidence interval [CI] 0.58-0.91) and Blacks (OR 0.44; 95% CI 0.30-0.63) had less COVID-19 vaccine acceptance, while Asians (OR 1.78; 95% CI 1.10-2.88) had greater vaccine acceptance. College graduation or more (OR 3.25; 95% CI 2.53-4.17), receipt or intention to receive the influenza vaccine (OR 3.46; 95% CI 2.22-5.41), and at least part-time employment (OR 2.12; 95% CI 1.66-2.72) were significantly associated with vaccine acceptance. Conclusions: COVID-19 vaccine nonacceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least part-time employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination.

Factors Associated with COVID‑19 Vaccine Uptake Among Adolescents and Young Adults Recently Diagnosed with Cancer

Adolescents and young adults (AYAs) recently diagnosed with cancer are medically vulnerable but little is known about vaccine uptake/intent in this group. AYAs reported on their COVID-19 vaccine uptake/intent. Logistic regression models examined factors associated with vaccine uptake. Higher education (adjusted odds ratio [aOR] = 1.9, 95% confidence interval [CI]: 1.0-3.5) and knowing someone diagnosed with COVID-19 (aOR = 7.2, 95% CI: 1.6-33.5) were associated with increased vaccine uptake. Prior personal diagnosis of COVID-19 (aOR = 0.1, 95% CI: 0.1-0.7) was associated with lower odds of uptake. Targeted interventions may be needed to improve uptake among this group. (ClinicalTrials.gov Identifier: NCT04585269).

Evaluating COVID-19 vaccine acceptance among parents in Saudi Arabia: a systematic review examining attitudes, hesitancy, and intentions

Introduction

The COVID-19 pandemic, affecting adults and children equally, has caused significant disruption to countries worldwide, including Saudi Arabia. In Saudi Arabia, the fast preventative measures and mass vaccine enrollment were vital to contain the devastating impact of the pandemic. However, vaccine hesitancy, especially among parents toward vaccinating their children, was a significant obstacle to vaccine uptake.

Methods

This systematic review followed PRISMA guidelines to assess parental willingness to vaccinate their children against COVID-19, determine the key determinants influencing such intention and attitudes, and underline the significant concerns and misconceptions regarding the vaccine among parents. The Joanne Briggs Institute (JBI) checklist for prevalence studies was used to assess included studies for risk of bias.

Results

Twenty-three studies were included in this systematic review, representing a total of 20,926 participants, with over 66% of them were female. Over 37% of the participants were willing to vaccinate their children against COVID-19. Parents' age, gender, level of education, and income were the main determinants of their intention to vaccinate their children. The parents' main concerns were the potential vaccine side effects, safety, and efficacy. Major misconceptions about the COVID-19 vaccine included it being dangerous to children and that children are at lower risk of severe infection; hence, vaccines were not needed.

Discussion

This seminal review provides insights to public health policymakers, which should be considered and taken together in light of other studies addressing parental vaccine hesitancy.

Public attitudes towards COVID-19 vaccine mandates and vaccine certificates in Canada: a time series study

INTRODUCTION

Since the beginning of the pandemic, numerous public health measures such as COVID-19 vaccines, vaccine mandates and vaccination certificates have been introduced to mitigate the spread of COVID-19. Public opinion and attitudes towards these measures have fluctuated in response to the dynamic political, social, and cultural landscape of the pandemic.

METHODS

We conducted a time-series study consisting of national cross-sectional surveys between November 2021 to March 2022 to evaluate the Canadian public's attitudes towards COVID-19 vaccine mandates and vaccine certificates.

RESULTS

When examining public sentiment towards COVID-19 vaccine certificates and proof of vaccination measures, there was a shift in responses over time. The proportion of participants "strongly supporting" these measures decreased from 66.0 to 43.1% between W25(Capacity Limits), -W32 (Mask Mandate Removed), whereas "strongly oppose" was the second most common response and rose from 15.9 to 20.6% during this same time period. Concurrently, when examining participants views surrounding mandates, many participants believed that their province was reopening at "about the right pace", which remained relatively stable over time (33.0-35.4%) between W28 (Emergency Act)-W32 (Mask Mandate Removed).

CONCLUSION

Our study's findings on the public's attitudes towards COVID-19 vaccine mandates and vaccine certificates in Canada may aid to guide and streamline the implementation of future similar public health interventions. Future research should include extended follow-up and a more comprehensive examination of trust in government institutions and polarized perspectives on vaccine mandates.