Passport to a Mighty Nation: Exploring Sociocultural Foundation of Chinese Public's Attitude to COVID-19 Vaccine Certificates

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

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

Nationalism, conspiracy theories and vaccine mandates: Exploring the statism determinants for attitudes to COVID-19 control in China

Introduction

China's loosening its COVID-19 controls highlighted its insufficiency in vaccination protection. Mandatory vaccination might be necessary if the gap cannot be filled over a short time. However, few studies have explored how Chinese people view the COVID-19 vaccine mandates, let alone placing such views in the country's highly politicized context.

Material and methods

The current study utilizes data from a national survey adopting quota sampling to analyze the Chinese public's medical and non-medical considerations when judging compulsory COVID-19 vaccination (n = 1,523). The survey was conducted between 1 and 8 April 2021. All adults aged 18 years and older were eligible to take part. The survey included sociodemographic details, perceived susceptibility to infection, perceived vaccine benefit, attitudes to vaccination policies, nationalism, beliefs in various conspiracy theories and science literacy. Multiple regression analyses were done to examine factors associated with the attitude to COVID-19 vaccine mandates.

Results

The study reveals that personal risk and benefit perceptions did not dominate the Chinese public's attitude toward vaccination mandates. Instead, nationalism was relatively strongly associated with their willingness to accept mandatory vaccination. Contrary to studies in the West, various conspiracy beliefs and conspiratorial thinking were robustly related to the support for mandatory vacciniation. Science literacy didn't link to the attitude to vaccination mandates. It only had a weak moderating effect on the influence of conspiratorial thinking on attitudes to the vaccination policies.

Conclusions

The results indicated that Chinese people's attitude to the COVID-19 vaccination policy is highly politicized and influenced by conspiracy theories. Given the potentially massive impacts of the COVID-19 infection, we need to educate the Chinese public with more medically valuable and relevant information to help them make sound decisions regarding vaccination. Meanwhile, we can adopt nationalistic tones to improve the persuasion effect, but misinformation during the process must be overcome.

Policy Endorsement and Booster Shot: Exploring Politicized Determinants for Acceptance of a Third Dose of COVID-19 Vaccine in China

China's recent termination of strict COVID-19 control necessitates taking a booster vaccine shot as a precaution against the pandemic as quickly as possible. A large body of research has examined people's attitudes toward and intentions for the booster shot. However, most studies failed to explore how China's sociopolitical context has shaped their attitude regarding the booster jab take-up. The current study utilizes data from a national survey adopting quota sampling to analyze the Chinese public's medical and non-medical considerations to determine their intention for the third dose of the COVID-19 vaccine. The study found that thanks to China's initial successful lockdown policies, personal risk and benefit perceptions did not dominate their views regarding booster vaccination. Instead, respondents' gender, nationalism, endorsement of the zero-COVID policy, self-efficacy regarding vaccination, and perceived infection severity were the major factors underlying their booster shot intention. The situation highlights how the politicized context of China's COVID-19 control has impacted people's plans to practice preventive behaviors. It is necessary to offset the negative consequences. One strategy is to educate the Chinese public with more medically relevant information to help them make rational choices regarding vaccination and other protective measures. On the other hand, such education can utilize this nationalistic mental status to enhance the persuasion effect.

Lower Carbon, Stronger Nation: Exploring Sociopolitical Determinants for the Chinese Public's Climate Attitudes

Although numerous studies have examined the Chinese public's attitudes towards climate change, few have shed light on how sociopolitical factors related to the policy and the state have shaped such attitudes. This constituted our research goal. Against the background of China's Dual Carbon Goals, a national survey (n = 1469) was conducted to investigate the relationships between climate attitudes and climate benefit perception, institutional trust, policy familiarity, nationalism, and environmental values. Findings showed that respondents shared a high score of nationalism and a high level of trust in Chinese institutions. Their national benefit perception of climate action, nationalism, and trust in national institutions were strong determinants of their attitudes towards climate change. The findings suggested that for many Chinese, a lower-carbon future will be accompanied by a coming stronger nation, which is a key driver for people to adopt positive attitudes towards addressing climate change. As such, the current study revealed an alternative landscape of the determinants underlying people's attitudes towards climate change. To our knowledge, this is the first scholarly effort in China to empirically demonstrate the predictive role of nationalistic value in shaping climate attitudes and is one of the earliest efforts in climate communication to test the impact of the policy on such attitudes.

Moving towards Digitising COVID-19 Vaccination Certificate: A Systematic Review of Literature

The coronavirus pandemic is the greatest crisis of our time, having claimed over 2 million lives and shocking the global economy. Scientists and governments have suggested the idea of a digital COVID-19 certificate, to identify vaccinated persons easily. This paper assesses the positions of stakeholders on COVID-19 vaccination certificates, their presentation, and their importance. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied in this study. Search terms with Boolean and/or operators were combined to increase relevant results. Four large digital databases were used for the search. Inclusion and exclusion criteria were used to screen 298 collated studies. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. It is essential to re-examine digital COVID-19 vaccination certificates, considering their benefits, such as real-time detection of fake vaccination certificates and identifying and mapping non-vaccinated areas for strategic vaccination planning. The use of a single electronic platform globally will ease verification processes while bringing economies back to their feet. Digital COVID-19 vaccination certificates may provide balance in this pandemic era. With digital COVID-19 certificate exceeding documentation purposes, it is important to recognise factors such as global economy and human rights, boosting free movements of persons.

Personal Narrative under Nationalism: Chinese COVID-19 Vaccination Expressions on Douyin

Scholars are divided over whether narrative/storytelling occupies a central position in health-related behaviour or in the health-related issues discussed on social media platforms. This study explored Chinese COVID-19 vaccination expressions on Douyin, China's biggest short-video sharing social media platform, and found that narration is still the most important tool employed by Chinese users when talking about COVID-19 vaccinations on Douyin, emphasizing nationalism and widespread optimism. Most of the narratives employed by Chinese users come from a first-person perspective. Nationalism, as manifested in the support expressed for national policies, rather than the external platform characteristics of memetics, makes the Chinese users' expressions about COVID-19 vaccinations similar on Douyin. Douyin seems to have become a 'pilgrimage platform' for the Chinese public to express their patriotic sentiment and their trust in the country and the government.

Public views on the Covid-19 immunity certificate: A scoping review

INTRODUCTION

Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance.

METHODS

We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions.

RESULTS

We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure.

CONCLUSION

The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it was a review paper.

Public Perceptions of Harms and Benefit of COVID-19 Immunity Certificate: A Cross-Sectional Study in the Italian Setting

A cross-sectional survey between 29 January 2022 and 3 February 2022 was conducted to understand the public rationale for accepting or rejecting the use of COVID-19 immunity certificates and to identify the psychosocial factors that mostly predict the positive/negative individuals’ perceptions of this measure. One thousand twenty-two Italian adults were recruited by a professional panel provider by employing a stratified sampling strategy controlled for gender, age, geographical area of residence, size of the urban centre of residence, employment, and wage. Eight Welch’s ANOVAs were then carried out to compare the perception of benefits and the perception of harms among different population groups. Multiple linear regression was carried out to measure the explained variance of benefits perception and harms perception by age, trust in institutions, and concern for health emergencies. The results shows that age, trust in institution, and concern for the COVID-19 emergency explain more variance of perceived benefits than of perceived harms of COVID-19 immunity certificates but the opposite regarding political orientation which explains perceived harms better than perceived benefits. The need for policy improvements is pressing because a large share of the world’s population remains unvaccinated. Moreover, our results can serve as vital information for similar health crises that may occur in the future. In addition, our results are expected to offer useful insights into public feelings around the use of digital health information tools.

A comparative analysis of COVID-19 vaccination certificates in 12 countries/regions around the world: Rationalising health policies for international travel and domestic social activities during the pandemic

As the unprecedented pandemic of COVID-19 became a major barrier during the past two years, many countries were using the “COVID pass” or COVID-19 vaccination certificates in attempts to facilitate effective international travel and domestic social activities. The difficulty remained in how the “COVID pass” from different countries and regions could be mutually recognised. This study surveys the current practice of COVID-19 vaccination certificates in 12 representative countries/regions around the world and provides a comprehensive mapping of the vaccination certificates in these countries/regions. The study compares and contrasts the vaccination certificates in both format and content, including their primary purposes, international accreditation, naming conventions, recipients’ personal information, and the details on vaccines and vaccination. The findings are interpreted in light of implementation practices in each country/region and discussed in relation to their various functions, as well as legal, technical, and ethical considerations. Based on the analysis and discussion recommendations are made on the practice of vaccination certificates in attempts to facilitate effective international travel and domestic social activities.

More engagement but less participation: China's alternative approach to public communication of science and technology

This essay critically traces the development of public engagement with science in China in the past decade and relevant scholarly studies. While confirming the country's tremendous progress in the field achieved either by official efforts or by social media empowerment, it argues that science communication advances have not realized the public engagement with science ideal of enabling the public to participate in constructive dialogue for policymaking. However, citing recent studies on the specifics of China's science communication, ranging from scientists' reliance on their organization, to the consequences of attitudinal polarization, this article appeals to an alternative research agenda to broaden our understanding of the dynamic science communication process in the world's most populous nation.

Public acceptability of COVID-19 control measures in Singapore, Hong Kong, and Malaysia: A cross-sectional survey

Background

Several countries have implemented control measures to limit SARS-CoV-2 spread, including digital contact tracing, digital monitoring of quarantined individuals, and testing of travelers. These raise ethical issues around privacy, personal freedoms, and equity. However, little is known regarding public acceptability of these measures.

Methods

In December 2020, we conducted a survey among 3635 respondents in Singapore, Hong Kong, and Malaysia to understand public perceptions on the acceptability of COVID-19 control measures.

Findings

Hong Kong respondents were much less supportive of digital contact tracing and monitoring devices than those in Malaysia and Singapore. Around three-quarters of Hong Kong respondents perceived digital contact tracing as an unreasonable restriction of individual freedom; <20% trusted that there were adequate local provisions preventing these data being used for other purposes. This was the opposite in Singapore, where nearly 3/4 of respondents agreed that there were adequate data protection rules locally. In contrast, only a minority of Hong Kong respondents viewed mandatory testing and vaccination for travelers as unreasonable infringements of privacy or freedom. Less than 2/3 of respondents in all territories were willing to be vaccinated against COVID-19, with a quarter of respondents undecided. However, support for differential travel restrictions for vaccinated and unvaccinated individuals was high in all settings.

Interpretation

Our findings highlight the importance of sociopolitical context in public perception of public health measures and emphasize the need to continually monitor public attitudes toward such measures to inform implementation and communication strategies.

The Effects of Media Encouragements on Coronavirus Vaccination Decision and Public Interest in Traveling Abroad

A lack of knowledge exists about individuals’ vaccination decisions and their relation to their tourism behaviors. In this regard, this study examines the willingness of international travelers to take a COVID-19 vaccine prior to traveling. A quantitative research design with a survey method and the ordinary least square (OLS) multiple regression analysis was used to test the hypotheses. The media encouragement positively affected the travelers’ attitude toward the behavior and their injunctive social norm, whereas the travelers’ attitude toward the behavior and injunctive social norm positively affected their COVID-19 vaccination intention. The regression results also proved the mediating effect of both attitudes toward the behavior and injunctive social norm in the relationship between media encouragement and COVID-19 vaccination intention. This research successfully provided evidence regarding the role of media encouragement in travelers’ willingness to take the COVID-19 vaccination.

Government Communication, Perceptions of COVID-19, and Vaccination Intention: A Multi-Group Comparison in China

Government communication has been playing an important role in mass vaccination to conduct the largest vaccination campaign of the world for COVID-19 and to counter vaccine hesitancy. This study employs the health belief model to examine the association between government communication and the COVID-19 vaccination intention. A survey of Chinese adults (N = 557) was conducted in March 2021, and partial least squares structural equation modeling was employed to estimate the multi-construct relationships. The findings indicate that government communication has both direct positive association with vaccination intention and indirect association with vaccination intention through the mediation of perceived severity, benefits, and barriers. Multi-group comparisons suggest that individuals from private sectors are more easily mobilized to receive COVID-19 vaccination by government communication than those from public sectors. Similarly, the correlation between government communication and the vaccination intention of individuals with a good health status was stronger than that of those with a poor health status. The theoretical and practical implications of these findings are further discussed.

Factors associated with the opposition to COVID-19 vaccination certificates: A multi-country observational study from Asia

BACKGROUND

There are ongoing calls to harmonise and increase the use of COVID-19 vaccination certificates (CVCs) in Asia. Identifying groups in Asian societies who oppose CVCs and understanding their reasons can help formulate an effective CVCs policy in the region. However, no formal studies have explored this issue in Asia.

METHOD

The COVID-19 Vaccination Policy Research and Decision-Support Initiative in Asia (CORESIA) was established to address policy questions related to CVCs. An online cross-sectional survey was conducted from June to October 2021 in nine Asian countries. Multivariable logistical regression analyses were performed to identify potential opposers of CVCs.

RESULTS

Six groups were identified as potential opposers of CVCs: (i) unvaccinated (Odd Ratio (OR): 2.01, 95% Confidence Interval (CI): 1.65-2.46); vaccine hesitant and those without access to COVID-19 vaccines; (ii) those not wanting existing NPIs to continue (OR: 2.97, 95% CI: 2.51-3.53); (iii) those with low level of trust in governments (OR: 1.25, 95% CI: 1.02-2.52); (iv) those without travel plans (OR: 1.58, 95% CI: 1.31-1.90); (v) those expecting no financial gains from CVCs (OR: 2.35, 95% CI: 1.98-2.78); and (vi) those disagreeing to use CVCs for employment, education, events, hospitality, and domestic travel.

CONCLUSIONS

Addressing recurring public health bottlenecks such as vaccine hesitancy and equitable access, adherence to policies, public trust, and changing the narrative from 'societal-benefit' to 'personal-benefit' may be necessary and may help increase wider adoption of CVCs in Asia.