Infodemic, Institutional Trust, and COVID-19 Vaccine Hesitancy: A Cross-National Survey

COVID-19 vaccination reluctance across Europe: Lessons for the future

BACKGROUND

Vaccine reluctance is both a complex and context-specific issue and is the result of many complicating factors that need to be addressed more systematically. In Europe, several country-based ad-hoc studies have been carried out on COVID-19 vaccines/vaccination and vaccine reluctance but a comprehensive overview covering all 27 European Union (EU27) countries is lacking. Such study can help understand vaccine reluctance in the overall EU as well as examine differences between individual countries.

METHODS

This study relies on data from Flash Eurobarometer 505, covering all 27 European Union member states; the sample size is N=26,641. It takes a fuzzy clustering approach to construct typologies of attitudes towards COVID-19 vaccination, and subsequently develops an "Index of Attitudes" (IA) which accounts for individual positioning of EU citizens. The data analysis is based on grade of membership (GoM) model which is a reliable statistical tool to tackle heterogeneous populations.

RESULTS

The output of GoM model unveiled a hierarchical fuzzy 3-partition corresponding to three clearly identified typologies of feelings towards COVID-19 vaccination: Typology 1 entails favourable feelings while moderate-favourable feelings describe the Typology 2. Finally, Tipology 3 encompasses the scepticism towards COVID-19 vaccines. The IA, which quantifies the sentiment of European citizens towards COVID-19 vaccination in a 0-1 scale, reveals that although EU27 citizens overall are not against COVID-19 vaccination (index mean =0.44) some, mostly in eastern countries, deviate from this prevailing trend.

CONCLUSION

Distrust in the safety and efficacy of all kinds of vaccines, as well as a generalised distrust in European and national institutions, are associated with the reluctance in relation towards COVID-19 vaccination. However, this reluctance varies across countries. The outcomes of our study not only inform national government and health care agents but also help define communication strategies to reach the most reluctant citizens. The segmentation it provides makes it easier to customise campaigns that raise awareness of the consequences of not being vaccinated, particularly as new SARS-CoV-2 variants emerge.

Integrating Science Media Literacy, Motivational Interviewing, and Neuromarketing Science to Increase Vaccine Education Confidence among U.S. Extension Professionals

This article presents an Integrative Model of Sustainable Health Decision-Making and a toolkit to equip U.S. Extension professionals with knowledge and skills to engage in adult immunization education. The objective was to reduce mistrust and increase willingness and confidence toward delivering vaccination education. The model was developed through an explanatory parallel mixed methods design. Data collection included a needs assessment survey, interviews, workshops, and Neuromarketing message testing. The resulting toolkit was pilot tested before final delivery. Four key needs were identified: tailoring trainings based on Extension roles, prioritizing preserving community trust and professional credibility, establishing connections with medical experts, and strengthening Science Media Literacy skills to counter misinformation and communicate emerging science. Correlations among constructs supported an integrated model focused on a professional development core of Science Media Literacy, Motivational Interviewing, and Neuromarketing Science that strengthens communication relationships between priority populations and trusted partners. The model and work described in this article can serve as a general framework for engaging key influencers in communities in communication education intended to promote sustainable well-being, such as increasing vaccine uptake.

Partisan Media, Trust, and Media Literacy: Regression Analysis of Predictors of COVID-19 Knowledge

BACKGROUND

The COVID-19 pandemic was a devastating public health event that spurred an influx of misinformation. The increase in questionable health content was aided by the speed and scale of digital and social media and certain news agencies' and politicians' active dissemination of misinformation about the virus. The popularity of certain COVID-19 myths created confusion about effective health protocols and impacted trust in the health care and government sectors deployed to manage the pandemic.

OBJECTIVE

This study explored how people's information habits, their level of institutional trust, the news media outlets they consume and the technologies in which they access it, and their media literacy skills influenced their COVID-19 knowledge.

METHODS

We administered a web-based survey using Amazon Mechanical Turk (MTurk) to assess US adults' (n=1498) COVID-19 knowledge, media and news habits, media literacy skills, and trust in government and health-related institutions. The data were analyzed using a hierarchical linear regression to examine the association between trust, media literacy, news use, and COVID-19 knowledge.

RESULTS

The regression model of demographic variables, political affiliation, trust in institutions, media literacy, and the preference for watching Fox or CNN was statistically significant (R2=0.464; F24,1434=51.653; P<.001; adjusted R2=0.455) in predicting COVID-19 knowledge scores. People who identified as politically conservative, watched Fox News, and reported lower levels of institutional trust and media literacy, scored lower on COVID-19 knowledge questions than those who identified as politically liberal, did not watch Fox News and reported higher levels of institutional trust and media literacy.

CONCLUSIONS

This study suggests that the media outlets people turn to, their trust in institutions, and their perceived degree of agency to discern credible information can impact people's knowledge of COVID-19, which has potential implications for managing communication in other public health events.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak

BACKGROUND

Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak.

METHODS

Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework.

RESULTS

Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities.

CONCLUSIONS

The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023

It is unclear how great a challenge pandemic and vaccine fatigue present to public health. We assessed perspectives on coronavirus disease 2019 (COVID-19) and routine immunization as well as trust in pandemic information sources and future pandemic preparedness in a survey of 23,000 adults in 23 countries in October 2023. The participants reported a lower intent to get a COVID-19 booster vaccine in 2023 (71.6%), compared with 2022 (87.9%). A total of 60.8% expressed being more willing to get vaccinated for diseases other than COVID-19 as a result of their experience during the pandemic, while 23.1% reported being less willing. Trust in 11 selected sources of vaccine information each averaged less than 7 on a 10-point scale with one's own doctor or nurse and the World Health Organization, averaging a 6.9 and 6.5, respectively. Our findings emphasize that vaccine hesitancy and trust challenges remain for public health practitioners, underscoring the need for targeted, culturally sensitive health communication strategies.

Management of infodemics in outbreaks or health crises: a systematic review

Introduction

The World Health Organization (WHO) defined an infodemic as an overabundance of information, accurate or not, in the digital and physical space, accompanying an acute health event such as an outbreak or epidemic. It can impact people's risk perceptions, trust, and confidence in the health system, and health workers. As an immediate response, the WHO developed the infodemic management (IM) frameworks, research agenda, intervention frameworks, competencies, and processes for reference by health authorities.

Objective

This systematic review explored the response to and during acute health events by health authorities and other organizations operating in health. It also assessed the effectiveness of the current interventions.

Methods

On 26 June 2023, an online database search included Medline (Ovid), Embase, Cochrane Library, Scopus, Epistemonikos, and the WHO website. It included English-only, peer-reviewed studies or reports covering IM processes applied by health organizations that reported their effectiveness. There was no restriction on publication dates. Two independent reviewers conducted all screening, inclusion, and quality assessments, and a third reviewer arbitrated any disagreement between the two reviewers.

Results

Reviewers identified 945 records. After a final assessment, 29 studies were included in the review and were published between 2021 and 2023. Some countries (Pakistan, Yemen, Spain, Italy, Hong Kong, Japan, South Korea, Singapore, United Kingdom, United States, New Zealand, Finland, South Korea, and Russia) applied different methods of IM to people's behaviors. These included but were not limited to launching media and TV conservations, using web and scientific database searches, posting science-based COVID-19 information, implementing online surveys, and creating an innovative ecosystem of digital tools, and an Early AI-supported response with Social Listening (EARS) platform. Most of the interventions were effective in containing the harmful effects of COVID-19 infodemic. However, the quality of the evidence was not robust.

Discussion

Most of the infodemic interventions applied during COVID-19 fall within the recommended actions of the WHO IM ecosystem. As a result, the study suggests that more research is needed into the challenges facing health systems in different operational environments and country contexts in relation to designing, implementing, and evaluating IM interventions, strategies, policies, and systems.

Perceptions around COVID-19 among patients and community members in urban areas in Cameroon: A qualitative perspective

At the onset of the COVID-19 pandemic, the Cameroonian government, to abide by international regulations, prescribed preventive measures, which affected many aspects of social, political, economic, and cultural life. However, there needs to be more in-depth exploration of how communities in Cameroon perceived and were impacted by COVID-19. We explored perceptions and misconceptions concerning COVID-19's impact on urban communities' daily lives in Cameroon. We conducted semi-structured interviews and focus group discussions with a heterogeneous sample of 25 participants from five different social categories (health personnel, patients with a confirmed COVID-19 infection, close contacts of patients, community members, and community leaders) to assess their perceptions of the disease. Interviews and FGDs were recorded, fully transcribed, coded manually, and analyzed using a thematic analysis iterative coding process. Three main themes were identified: 1) Knowledge of COVID-19: antagonism between disease and invention, 2) Barrier measures imposed by the "dominant culture," and 3) Impact of COVID-19 on daily lives. Our study revealed perceptions around general knowledge of the COVID-19 pandemic, noting acceptance and observation of government-imposed protective measures while highlighting the significant changes endured in participants' daily lives. These findings draw attention to the need to develop flexible and appropriate response strategies for different communities. Although Cameroonian populations were not as intensely affected by the burden of the disease of COVID-19 as other regions, they were still compelled to follow static "cookie-cutter" measures that were internationally imposed, affecting their daily lives in ways that seemed disproportionate to their own experiences of the crisis. These findings have potential implications for the legitimacy of public health institutions and responses.

COVID-19 risk communication gaps, needs, and strategies related to pandemic preparedness plans among vulnerable, Black American subgroups: A qualitative study

OBJECTIVE

Improving current and future risk communication plans is critical to mitigate the COVID-19 pandemic and begin to prepare for future pandemics. Minority groups, particularly African Americans, have been limited in engagement to prepare these plans which has been demonstrated to be disadvantageous. We report findings from a qualitative study that describes gaps, needs, and strategies to improve communication among vulnerable, Black American subgroups during the COVID-19 pandemic.

METHODS

Sixty-two Black Americans in uniquely, vulnerable subgroups participated in qualitative, semi-structured interviews from May to September 2020. Thematic analyses were used to identify themes.

RESULTS

Participants were 16 essential workers, 16 parents, 15 young adults, and 15 individuals with underlying medical conditions. Emerging themes were: (1) Poor communication and miscommunication fueled fear and confusion; (2) Information sources and channels: How do I choose one?; (3) Communication needs were simple yet complex; (4) All information sources are not trusted information sources; (5) Preferred yet trusted channels and types of information; and (6) Dissemination of COVID Research: Why and How. Subgroups varied in information sources and processes for choosing the source, communication needs, and channels and types of information needed. They shared why they did and did not trust certain sources along with the importance of COVID research dissemination to promote informed decision-making throughout the pandemic.

DISCUSSION

This study found that Black American subgroups had diverse, yet trusted and non-trusted messages, messengers, and strategies for communication and wanted research results disseminated. We describe multi-level stakeholders and strategies to help improve risk communication for pandemics, and potentially preparedness and health outcomes.

Global Challenges After a Global Challenge: Lessons Learned from the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) has affected not only individual lives but also the world and global systems, both natural and human-made. Besides millions of deaths and environmental challenges, the rapid spread of the infection and its very high socioeconomic impact have affected healthcare, economic status and wealth, and mental health across the globe. To better appreciate the pandemic's influence, multidisciplinary and interdisciplinary approaches are needed. In this chapter, world-leading scientists from different backgrounds share collectively their views about the pandemic's footprint and discuss challenges that face the international community.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Awareness of and attitude toward COVID-19 vaccination among individuals with COPD and the strategies to overcome vaccine hesitation: A mini review

Coronavirus Disease 2019 (COVID-19) vaccines have a protective effect on individuals with chronic obstructive pulmonary disease (COPD), preventing them from developing severe illnesses and reducing the risk of hospitalization and mortality. However, the coverage rate of COVID-19 vaccination among this population is not satisfactory, which is associated with their lack of awareness of and negative attitudes toward COVID-19 vaccination, that is, vaccine hesitancy. We reviewed recent literatures on the vaccination status of COPD patients and vaccine hesitancy, described the factors related to vaccine hesitancy among COPD patients, and proposed strategies to improve the vaccine coverage, such as providing accurate and consistent vaccine information to the public, patient health education program, improving self-management capabilities, easy access to vaccination service, etc., which can hopefully help to improve patients' ability to cope with SARS-CoV-2 infection and reduce the COVID-19 related mortality.

Information Consumption, Trust Dynamics and COVID-19 Vaccine Hesitancy among Older Adults: Implications for Health Messaging

Staying well informed about the evolving COVID-19 pandemic and vaccine recommendations is vital for older adults, especially for low-income older adults, who have been disproportionately impacted by the pandemic. However, the overwhelming infodemic poses a significant challenge, affecting vaccine decision-making. This study explores how a group of predominantly low-income older adults navigate health information and how their trust in information and vaccines evolves throughout the pandemic. Our objective is to provide insights that will guide future public health messaging for this demographic. Analyzing qualitative data from 77 older adults (aged 65 to 94) collected through focus groups and interviews, our findings reveal that participants' experiences with information overload eroded their trust in authority, leading to vaccine hesitancy. Moreover, the need for a booster has affected belief in vaccine safety and efficacy. As participants lost faith in the media and authoritative sources, they increasingly leaned on personal networks for guidance. These results underscore the urgent necessity for clear, unambiguous ongoing vaccine guidance to restore institutional trust among older adults. Additionally, recognizing the influential role of direct networks in vaccine decisions, integrating care workers, service providers, and peer-to-peer support into health messaging mechanisms could prove valuable.

Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey

BACKGROUND

Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30% of US adults remain unvaccinated against COVID-19. The majority (81%) of these unvaccinated adults say they will "definitely not" be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster.

OBJECTIVE

This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19-specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity.

METHODS

We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19-specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no.

RESULTS

Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19-related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake.

CONCLUSIONS

The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance.

Users' Motivations for Facebook Unfriending During the COVID-19 Pandemic: Survey Study

BACKGROUND

Social networking sites (SNSs) such as Facebook have been central to the global exchange of health-related information throughout the COVID-19 pandemic, but during this time, increased web-based interactions proved to be a source of stress and conflict for many SNS users. Prior research suggests that many users have engaged in significant boundary regulation during this period, using behaviors such as unfriending to refine and reorient their social networks in response to pandemic-related information.

OBJECTIVE

This study aimed to examine Facebook unfriending during and in relation to the first year of the pandemic to better understand how SNS users have managed and maintained their social networks around the COVID-19 pandemic. On the one hand, unfriending may be motivated by an attempt to protect the utility and accuracy of a user's informational environment. On the other hand, it may be motivated by a desire to tune out alternative viewpoints and opinions. Both motivations may have significant implications for public health discourse and outcomes.

METHODS

A sample of 824 active Facebook users (drawn from a representative survey of 1000 American adults) was analyzed using a series of logit regression models. Survey respondents were selected using a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by the region of the country) for sex, age, race, ethnicity, and political affiliation.

RESULTS

In total, 31.7% (261/824) of active Facebook users unfriended at least one account over COVID-19 pandemic-related posts during the first year of the pandemic. The most common reasons for unfriending included "making political comments about COVID-19" (191/824, 23.2%) and "posting information that was inconsistent with public health guidelines" (162/824, 19.7%). As hypothesized, reliance on Facebook for COVID-19 pandemic-related news and information was associated with a greater likelihood of unfriending, particularly in response to information that was inconsistent with public health guidelines. Political factors (particularly partisan intensity) were also predictive of unfriending, especially in the case of COVID-19 pandemic-related disagreements.

CONCLUSIONS

Both information utility concerns and political factors were associated with a greater likelihood of COVID-19 pandemic-related unfriending, although the magnitude of the effects associated with utility appears to be greater. Although utility-motivated unfriending may lead to more reliable health information experiences for some SNS users, the tendency of consumers to assess accuracy and credibility on the basis of partisan predilections obscures this finding and warrants further consideration.

Bibliometric and visual analysis of vaccination hesitancy research from 2013 to 2022

Although vaccination is regarded as one of the most significant achievements of public health, there also exists the phenomenon of vaccination hesitancy which refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. In this study, we conducted a bibliometric analysis to provide a comprehensive overview of vaccination hesitancy research from 2013 to 2022. All related publications were retrieved from the Web of Science Core Collection Database. Information on annual publications, countries, organizations, journals, authors, keywords, and documents was analyzed adopting the bibliometix R-package, VOSviewer, and CiteSpace software. A total of 4042 publications were enrolled. The annual publications increased slightly before 2020 but had an extremely dramatic increase from 2020 to 2022. The United States contributed the most articles and had the greatest collaboration with other countries and organizations. The London School of Hygiene & Tropical Medicine was the most active institution. Vaccine was the most cited and influential journal while Vaccines was the most productive journal. It was Dube E who was the most productive authors with the highest h-index. The most frequent keywords were "vaccine hesitancy," "COVID-19," "SARS-CoV2," "immunization," "attitudes," and "willingness." Vaccination hesitancy to some extent hinders the achievement of global public health. The influencing factors vary across time, space, and vaccines. The COVID-19 pandemic and the development of COVID-19 vaccines have made this issue the focus of interest. The complexity and specific contexts of influencing factors of vaccination hesitancy require further study and will potentially be the focus of future research direction.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Can Risk Communication Surveillance Prompt COVID-19 Vaccine Acceptance among Internet users? Applying the Situational Theory of Problem Solving: A Cross-Sectional Study

BACKGROUND

The World Health Organization has recently raised concerns about the low number of fully vaccinated people against COVID-19 among developing countries. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine-related infodemics as the significant risk perception factor that hinders mass vaccination campaigns.

OBJECTIVE

Given the ambiguous digital communication environment which has fostered infodemics, developing nations struggle to boost public willingness to get people fully vaccinated. Authorities have launched some risk communication-laden digital interventions in response to infodemics. However, the value of these risk communication strategies employed to tackle infodemics needs to be evaluated. The current research using the tenets of the situational theory of problem-solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception about COVID-19 vaccine safety and risk communication actions to intensify willingness to get fully vaccinated was examined.

METHODS

This research used a cross-sectional research design vis-à-vis nationally representative online survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after filling consent form and reading the ethical permissions. Responses were received over three months, from May 2022 to July 2022.

RESULTS

The results delineated that infodemics positively affect risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and search for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (e.g., digital interventions) using the situational context could predict robust willingness to get fully vaccinated against COVID-19.

CONCLUSIONS

The pioneering results offer strategic considerations for health authorities to effectively man-age the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using the situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underpinning problem (i.e., selection of appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response.

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

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

Effects of Negative Attitudes towards Vaccination in General and Trust in Government on Uptake of a Booster Dose of COVID-19 Vaccine and the Moderating Role of Psychological Reactance: An Observational Prospective Cohort Study in Hong Kong

Uptake of a booster dose of COVID-19 vaccine is effective in preventing infection and severe consequences caused by COVID-19. The present study examined the effects of negative attitudes towards vaccination in general and trust in government on uptake of a COVID-19 booster dose, as well as the moderating role of psychological reactance to pro-vaccination messages in Hong Kong. An observational prospective cohort study using online survey was conducted among 264 adults. Findings showed that, after adjustment for significant background characteristics, negative attitudes towards vaccination in general negatively predicted uptake of a booster dose, and trust in government positively predicted uptake of a booster dose. In addition, the association between negative attitudes towards vaccination in general and uptake of a booster dose was weaker among those who reported a higher level of psychological reactance. The present study highlighted the importance of improving attitudes towards vaccination in general especially among those who are not experiencing psychological reactance, and building trust in government. This study also suggested that interventions aimed at improving attitudes towards vaccination in general should seek to avoid psychological reactance, and special attention should be given to people who are experiencing psychological reactance to pro-vaccination messages.

The Role of Conspiracy Theories, Perceived Risk, and Trust in Science on COVID-19 Vaccination Decisiveness: Evidence from Cyprus

COVID-19 reminded us of the importance of vaccinating for successfully overcoming health-related crises. Yet, vaccine hesitancy is still present. This study examined the impacts of conspiracy theories, perceived risk, and trust in science on COVID-19 vaccination decisiveness. The study was conducted at the end of the third wave of the pandemic, in July 2021, in Cyprus. Data were collected via an online self-administered anonymous survey using convenience and snowball sampling methods. Participants were 363 adults who completed a set of questionnaires that examined their believability in ten vaccine-related conspiracy theories, their perceived dangerousness of COVID-19, and their level of trust in science and scientists. The results suggest that (a) participants with a high conspiracy theory belief are less likely to be vaccinated, (b) participants who perceive COVID-19 as a dangerous disease are more likely to be vaccinated, and (c) participants with high trust in science are more likely to be vaccinated. The implications of the findings are discussed and can be used by public health officials in their campaigns.

Cognitive and Cultural Factors That Affect General Vaccination and COVID-19 Vaccination Attitudes

The development of COVID-19 vaccines is a major scientific accomplishment that has armed communities worldwide with powerful epidemic control tools. Yet, COVID-19 vaccination efforts in the US have been marred by persistent vaccine hesitancy. We used survey methodology to explore the impact of different cognitive and cultural factors on the public's general vaccination attitudes, attitudes towards COVID-19 vaccines, and COVID-19 vaccination status. The factors include information literacy, science literacy, attitudes towards science, interpersonal trust, public health trust, political ideology, and religiosity. The analysis suggests that attitudes towards vaccination are influenced by a multitude of factors that operate in a complex manner. General vaccination attitude was most affected by attitudes towards science and public health trust and to a lesser degree by information literacy, science literacy, and religiosity. Attitudes towards COVID-19 vaccines were most affected by public health trust and to a lesser extent by general trust, ideology and attitudes towards science. Vaccination status was most influenced by public health trust. Possible mediating effects of correlated variables in the model need to be further explored. The study underscores the importance of understanding the relationship between public health trust, literacies, and sociocultural factors.

Evolution and Control of COVID-19 Epidemic in Hong Kong

Hong Kong SAR has adopted universal masking, social distancing, testing of all symptomatic and high-risk groups for isolation of confirmed cases in healthcare facilities, and quarantine of contacts as epidemiological control measures without city lockdown or border closure. These measures successfully suppressed the community transmission of pre-Omicron SARS-CoV-2 variants or lineages during the first to the fourth wave. No nosocomial SARS-CoV-2 infection was documented among healthcare workers in the first 300 days. The strategy of COVID-19 containment was adopted to provide additional time to achieve population immunity by vaccination. The near-zero COVID-19 situation for about 8 months in 2021 did not enable adequate immunization of the eligible population. A combination of factors was identified, especially population complacency associated with the low local COVID-19 activity, together with vaccine hesitancy. The importation of the highly transmissible Omicron variant kickstarted the fifth wave of COVID-19, which could no longer be controlled by our initial measures. The explosive fifth wave, which was partially contributed by vertical airborne transmission in high-rise residential buildings, resulted in over one million cases of infection. In this review, we summarize the epidemiology of COVID-19 and the infection control and public health measures against the importation and dissemination of SARS-CoV-2 until day 1000.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China

Objective

The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China.

Methods

From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model.

Result

Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions.

Conclusion

The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

COVID-19 Vaccine Acceptance and Its Determinants among Myanmar Migrant Workers in Southern Thailand

Success in eradicating COVID-19 will rely on the rate of vaccination adoption worldwide. Vaccine acceptance among vulnerable groups is critical for preventing the spread of COVID-19 and decreasing unnecessary deaths. The purpose of this study was to report on the willingness to obtain COVID-19 immunization and the factors related to its acceptance among Myanmar migrant workers in southern Thailand. This cross-sectional study consisted of 301 samples collected between October and November 2021 and analyzed using multiple logistic regression. Thirty-nine percent of workers intended to receive the COVID-19 vaccine within a year. The following factors were associated with obtaining the COVID-19 vaccine: a high level of perception of COVID-19 (AOR = 5.43), income less than or equal to 10,000 baht/month (AOR = 6.98), financial status at a sufficient level (AOR = 7.79), wearing a face mask in the previous month almost all the time (AOR =4.26), maintaining 1-2 m of distance from anyone in the last month (AOR =2.51), and measuring temperature in the previous month (AOR = 5.24). High reluctance to accept the COVID-19 vaccine among Myanmar migrant workers can influence efforts to eliminate COVID-19. Collaboration with all stakeholders is critical to helping Myanmar workers understand COVID-19, social measures, and preventive beliefs to increase vaccine uptake.

A Practical Framework for Academics to Implement Public Engagement Interventions and Measure Their Impact

Academic institutions have shown an increased interest in the so-called third mission to offer an impactful contribution to society. Indeed, public engagement programs ensure knowledge transfer and help to inspire positive public discourse. We aimed to propose a comprehensive framework for academic institutions planning to implement a public engagement intervention and to suggest potential indicators to measure its impact. To inform the framework development, we searched the literature on public engagement, the third mission, and design theory in electronic databases and additional sources (e.g., academic recommendations) and partnered with a communication agency offering non-academic advice. In line with this framework, we designed a public engagement intervention to foster scientific literacy in Italian youth, actively involving them in the development of the intervention. Our framework is composed of four phases (planning/design, implementation, immediate impact assessment, and medium- and long-term assessment). Impact indicators were subdivided into outcome variables that were immediately describable (e.g., changed understanding and awareness of the target population) and measurable only in the medium or long run (e.g., adoption of the intervention by other institutions). The framework is expected to maximize the impact of public engagement interventions and ultimately lead to better reciprocal listening and mutual understanding between academia and the public.

COVID-19 Vaccine Booster Dose Acceptance: Systematic Review and Meta-Analysis

The World Health Organization (WHO) recommended coronavirus disease 2019 (COVID-19) booster dose vaccination after completing the primary vaccination series for individuals ≥18 years and most-at-risk populations. This study aimed to estimate the pooled proportion of COVID-19 vaccine booster dose uptake and intention to get the booster dose among general populations and healthcare workers (HCWs). We searched PsycINFO, Scopus, EBSCO, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, Web of Science, Google Scholar, and ScienceDirect according to PRISMA guidelines. From a total of 1079 screened records, 50 studies were extracted. Meta-analysis was conducted using 48 high-quality studies according to the Newcastle-Ottawa Scale quality assessment tool. Using the 48 included studies, the pooled proportion of COVID-19 vaccine booster dose acceptance among 198,831 subjects was 81% (95% confidence interval (CI): 75-85%, I2 = 100%). The actual uptake of the booster dose in eight studies involving 12,995 subjects was 31% (95% CI: 19-46%, I2 = 100%), while the intention to have the booster dose of the vaccine was 79% (95% CI: 72-85%, I2 = 100%). The acceptance of the booster dose of COVID-19 vaccines among HCWs was 66% (95% CI: 58-74%), I2 = 99%). Meta-regression revealed that previous COVID-19 infection was associated with a lower intention to have the booster dose. Conversely, previous COVID-19 infection was associated with a significantly higher level of booster dose actual uptake. The pooled booster dose acceptance in the WHO region of the Americas, which did not include any actual vaccination, was 77% (95% CI: 66-85%, I2 = 100%). The pooled acceptance of the booster dose in the Western Pacific was 89% (95% CI: 84-92%, I2 = 100), followed by the European region: 86% (95% CI: 81-90%, I2 = 99%), the Eastern Mediterranean region: 59% (95% CI: 46-71%, I2 = 99%), and the Southeast Asian region: 52% (95% CI: 43-61%, I2 = 95). Having chronic disease and trust in the vaccine effectiveness were the significant predictors of booster dose COVID-19 vaccine acceptance. The global acceptance rate of COVID-19 booster vaccine is high, but the rates vary by region. To achieve herd immunity for the disease, a high level of vaccination acceptance is required. Intensive vaccination campaigns and programs are still needed around the world to raise public awareness regarding the importance of accepting COVID-19 vaccines needed for proper control of the pandemic.

Contextualized impacts of an infodemic on vaccine hesitancy: The moderating role of socioeconomic and cultural factors

This study examines how perceived information overload and misinformation affect vaccine hesitancy and how this is moderated by structural and cultural factors. By applying and extending the fundamental cause theory, this study proposes a contextualized impact model to analyze a cross-national survey of 6034 residents in six societies in Asia, Europe and North America in June 2021. The study finds that (1) Older and highly-educated participants were less susceptible to COVID-19 information overload and belief in vaccine misinformation. (2) Perceived information overload led to an increase in vaccine acceptance and uptake, whereas belief in vaccine misinformation caused a decrease. (3) The structural differentiation of vaccine hesitancy was salient and higher socioeconomic status could buffer the negative impact of misinformation on vaccine acceptance. (4) Cultural factors such as collectivism and authoritarian mentality also served as buffers against the misinformation that reduced vaccine acceptance and uptake. These findings add nuanced footnotes to the fundamental causes theory and contribute to the discussion on the global recovery from the infodemic. Besides fact-checking and improving individual information literacy, effective and long-term information management and health policies must pay attention to stratified information gaps across socioeconomic groups, and to contextualize the communication and intervention strategies in different cultures.

Distrustful, Dissatisfied, and Conspiratorial: A Latent Profile Analysis of COVID-19 Vaccination Rejection

Trust in science and scientists, satisfaction with the national government, and endorsement of conspiracy theories are important factors in the decision to be vaccinated. In this study, we investigated whether there are different profiles of individuals depending on the above factors and whether they differ in their sociodemographic composition. We used data from Round 10 of the European Social Survey for Slovenia, employing a nationally representative sample of 1252 participants. Based on latent profile analysis, three distinct profiles emerged: Profile 1 expressed moderate trust in science, satisfaction with government, and high endorsement of conspiracies; Profile 2 expressed low trust and satisfaction and moderate endorsement of conspiracies; Profile 3 expressed high trust and satisfaction and low beliefs in conspiracy theories. In addition, Profile 3 expressed the strongest support for vaccination and Profile 2 the lowest. Our results suggest that distrust, dissatisfaction, and the presence of conspiracy theories are the "perfect storm" for vaccination rejection. In contrast, despite conspiracy theories, a certain level of trust and satisfaction may reduce vaccination rejection.