COVID-19 Vaccine Hesitancy: The Role of Socioeconomic Factors and Spatial Effects

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.

Characteristics Associated With Homebound Vaccination Against COVID-19

OBJECTIVES

Homebound patients are older and suffer from multiple comorbidities, and many experienced difficulties getting vaccinated because of their inability to routinely leave the home due to health and function. Home-based primary care (HBPC) programs offer vaccination at home to reach this high-risk population. We evaluated an urban HBPC program's COVID-19 vaccination campaign to explore whether home-based vaccination can reduce inequity in vaccine administration or improve vaccine efforts.

DESIGN

We conducted a cross-sectional study to examine characteristics of homebound patients who were vaccinated through an HBPC program or were vaccinated elsewhere.

SETTING AND PARTICIPANTS

We analyzed 795 patients enrolled in the HBPC program who were eligible for vaccination at home in 2021.

METHODS

We collected vaccination data from patients, demographic data from the electronic medical record, and neighborhood-level characteristics for each patient based on census tract.

RESULTS

Homebound patients vaccinated by HBPC were significantly more likely than homebound patients vaccinated outside of the program to have a history of dementia (P = .003), live in public housing (P < .001), have Medicaid (P = .005), be enrolled in HBPC for longer (P = .03), and live in neighborhoods with higher proportions of immigrants (P = .022), lower English proficiency (P = .007), lower computer usage (P = .001), and greater poverty (P < .001).

CONCLUSION AND IMPLICATIONS

Home-based vaccination campaigns may help lower-resourced patients get vaccinated by mitigating logistic barriers and using the influence of trusted patient-provider relationships established through HBPCs.

A Study Examining the Impact of County-Level Demographic, Socioeconomic, and Political Affiliation Characteristics on COVID-19 Vaccination Patterns in Indiana

The COVID-19 vaccination campaign resulted in uneven vaccine uptake throughout the United States, particularly in rural areas, areas with socially and economically disadvantaged groups, and populations that exhibited vaccine hesitancy behaviors. This study examines how county-level sociodemographic and political affiliation characteristics differentially affected patterns of COVID-19 vaccinations in the state of Indiana every month in 2021. We linked county-level demographics from the 2016-2020 American Community Survey Five-Year Estimates and the Indiana Elections Results Database with county-level COVID-19 vaccination counts from the Indiana State Department of Health. We then created twelve monthly linear regression models to assess which variables were consistently being selected, based on the Akaike Information Criterion (AIC) and adjusted R-squared values. The vaccination models showed a positive association with proportions of Bachelor's degree-holding residents, of 40-59 year-old residents, proportions of Democratic-voting residents, and a negative association with uninsured and unemployed residents, persons living below the poverty line, residents without access to the Internet, and persons of Other Race. Overall, after April, the variables selected were consistent, with the model's high adjusted R2 values for COVID-19 cumulative vaccinations demonstrating that the county sociodemographic and political affiliation characteristics can explain most of the variation in vaccinations. Linking county-level sociodemographic and political affiliation characteristics with Indiana's COVID-19 vaccinations revealed inherent inequalities in vaccine coverage among different sociodemographic groups. Increased vaccine uptake could be improved in the future through targeted messaging, which provides culturally relevant advertising campaigns for groups less likely to receive a vaccine, and increasing access to vaccines for rural, under-resourced, and underserved populations.

Vaccination homophily in ego contact networks during the COVID-19 pandemic

Vaccine hesitancy is an inevitable risk for societies as it contributes to outbreaks of diseases. Prior research suggests that vaccination decisions of individuals tend to spread within social networks, resulting in a tendency to vaccination homophily. The clustering of individuals resistant to vaccination can substantially make the threshold necessary to achieve herd immunity harder to reach. In this study, we examined the extent of vaccination homophily among social contacts and its association with vaccine uptake during the COVID-19 pandemic in Hungary using a contact diary approach in two cross-sectional surveys. The results indicate strong clustering among both vaccinated and unvaccinated groups. The most powerful predictor of vaccine uptake was the perceived vaccination rate within the egos' social contact network. Vaccination homophily and the role of the interpersonal contact network in vaccine uptake were particularly pronounced in the networks of close relationships, including family, kinship, and strong social ties of the ego. Our findings have important implications for understanding COVID-19 spread dynamics by showing that the strong clustering of unvaccinated individuals posed a great risk in preventing the spread of the disease.

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

A pre-post evaluation study of a social media-based COVID-19 communication campaign to improve attitudes and behaviors toward COVID-19 vaccination in Tanzania

In Tanzania, the One by One: Target COVID-19 campaign was launched nationally in July 2022 to address the prevalent vaccine hesitancy and lack of confidence in COVID-19 vaccines. The campaign mobilized social media influencers and viral content with the ultimate goal of increasing COVID-19 vaccine uptake in the country. The objective of this study was to empirically assess the impact of the campaign on three outcomes: vaccine confidence, vaccine hesitancy, and vaccination status. Using programmatic data collected through an online survey before and after the campaign, we conducted a difference-in-difference (DiD) analysis and performed a crude, adjusted, and propensity score-matched analysis for each study outcome. Lastly, to observe whether there was any differential impact of the campaign across age groups, we repeated the analyses on age-stratified subgroups. Data included 5,804 survey responses, with 3,442 and 2,362 responses collected before and after the campaign, respectively. Although there was only weak evidence of increased COVID-19 vaccine confidence in the campaign-exposed group compared to the control group across all age groups, we observed a differential impact among different age groups. While no significant change was observed among young adults aged 18-24 years, the campaign exposure led to a statistically significant increase in vaccine confidence (weighted/adjusted DiD coefficient = 0.76; 95% CI: 0.06, 1.5; p-value = 0.034) and vaccination uptake (weighted/adjusted DiD coefficient = 1.69.; 95% CI: 1.02, 2.81; p-value = 0.023) among young adults aged 25-34 years. Among adults aged 35 years and above, the campaign exposure led to a significant decrease in vaccine hesitancy (weighted/adjusted DiD coefficient = -15; 95% CI: -21, -8.3; p-value<0.001). The social media campaign successfully improved vaccine hesitancy, confidence, and uptake in the Tanzanian population, albeit to varying degrees across age groups. Our study provides valuable insights for the planning and evaluation of similar social media communication campaigns aiming to bolster vaccination efforts.

Socioeconomic determinants of COVID-19 vaccine acceptance

The aim of the paper is to evaluate the relative importance of the set of socioeconomic characteristics of population on collective decision on COVID-19 vaccine acceptance. We apply cross-section OLS methods to the municipal-level non-survey data for 145 municipalities in Serbia, on the COVID-19 vaccination rate and socioeconomic characteristics of the population, to evaluate the determinants of cross-municipal variation in vaccine uptake decision. Using the estimated coefficients from the OLS regressions, we apply the standardized beta method to evaluate the relative importance of each factor. Vaccine acceptance in municipalities rises with the average level of education (especially in the female population), age and employment, while being negatively linked to religiosity of people and the proportion of rural population. We also find some evidence on the positive impact of the overall trust in government. Education level has the single largest impact, shaping around 37% of (explained) variation in the vaccination rate across municipalities, a rise in the proportion of people with higher degree by 1% being associated with increase in vaccination rate by 0.36%. Age of population explains 21%, urban-rural structure 13% and religiosity 11% of variation in vaccine acceptance, while employment status and trust in government each explain around 9% of variation in vaccine uptake across municipalities. Effective vaccination promotion strategy should be focused on younger, less-educated, unemployed cohorts, as well as on rural areas and should involve representatives of mainstream religions. Fostering education and strengthening trust in government are some of the key structural factors that may promote efficient collective behaviour in this respect.

Influence of Community Determinants on Barriers and Facilitators to COVID-19 Vaccine Uptake: Regional Stakeholders' Perspectives

Our study objective was to explore possible pathways by which neighborhood-level characteristics drive COVID-19 vaccination among communities experiencing health inequity and disparities. To do so, we conducted semi-structured qualitative interviews with stakeholders in the Finger Lakes region of New York between November 2022 through January 2023. Using a pre-developed interview guide informed by the Health Belief Model, we elicited county health commissioner, medical professional and community-health partner's perspectives regarding the impact community determinants have on shaping barriers to and facilitators of COVID-19 vaccine uptake, as well as recommended solutions for ensuring health equity in future vaccination efforts. Fifteen stakeholders were interviewed, of which 40% were county health commissioners, 27% hospital executives and 33% community-health organization partners. We identified diverse perceived and logistical barriers to COVID-19 vaccination that emerged as sub-themes including perceived risks outweighing the benefits of vaccination, concerns of vaccine safety, distrust stemming from changing scientific knowledge surrounding the vaccines, mistrust of the medical system, and challenges with transportation to and registering for vaccine appointments. Stakeholders reported these barriers were linked to the racial diversity, poverty, political conservatism, and availability of health care of the communities where they reported these were experienced. Notable solutions for improving equitable vaccination included facilitating structural access to vaccination and engaging community trusted messengers. Perceived and experienced barriers to COVID-19 vaccination may differ based upon the social, racial and economic composition of neighboring communities. Strategies for ensuring health equity in future vaccination campaigns should specifically target prevalent barriers based upon the community composition.

Hesitancy or Resistance? Differential Changes in COVID-19 Vaccination Intention Between Black and White Americans

The literature on COVID-19 vaccination has rarely taken a macro and longitudinal approach to investigate the nuanced racial and ethnic differences in vaccine hesitancy and refusal. To fill this gap, this study examines the relationships between race, time, and COVID-19 vaccine hesitancy and refusal using state-level data from the US Census Household Pulse Survey, 2020 US Decennial Census, and other sources (i.e., American Community Survey, Human Development Index database, and Centers for Disease Control and Prevention). Four longitudinal Generalized Estimating Equations (GEEs) were estimated to analyze how time-variant and time-invariant measures, and time itself influenced COVID-19 vaccine hesitancy and refusal rates, controlling for the effect of other relevant covariates. The results provide descriptive evidence that COVID-19 vaccine hesitancy had decreased in the USA, but vaccine refusal remained stable between January and October 2021. The GEEs further indicated that the proportion of the Black population was positively associated with both vaccine hesitancy and refusal rates, while the proportion of the White population was positively associated with the vaccine refusal rate but not associated with the vaccine hesitancy rate. In addition, over the 10-month period, COVID-19 vaccine hesitancy and refusal in the Black population declined rapidly, but vaccine refusal in the White population stayed fairly stable. More research and practical efforts are needed to understand and inform the public about these important but overlooked trends.

Psychological reactance, misinformation, and distrust: A mixed methods analysis of COVID-19 vaccine uptake

Background

Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities.

Methods

This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47).

Results

The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom.

Conclusion

Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.

Assessment of willingness and determinants to receive the COVID-19 vaccine among the general population of the Somali region, Eastern Ethiopia: a 2021 cross-sectional study

OBJECTIVE

This research aimed to assess COVID-19 vaccine acceptance and the factors influencing it among the population of the Somali region in Ethiopia through a cross-sectional COVID-19 survey.

DESIGN

Community-based cross-sectional study.

SETTING

The survey was conducted in eight selected districts of the Somali region in Ethiopia from 20 October 2021 to 30 October 2021.

PARTICIPANTS

Participants were chosen using simple random sampling and data analysis used Stata V.14. Both bivariable and multivariable binary logistic regression methods were applied, with variables having a p value below 0.2 considered for inclusion in the final model, where statistically significant factors were identified at p<0.5.

PRIMARY OUTCOME MEASURE

Willingness to take the vaccine.

RESULTS

A total of 1010 respondents participated in this study. The proportion of people's willingness to take the vaccine was 65% (95% CI 62 to 68). When you believe moderately or highly that getting a COVID-19 vaccine will protect others (AOR=6.2, 95% CI 1.43 to 26.6) and (AOR=7.2, 95% CI 1.7 to 29.7), then you will protect others as well. Whereas, a desire to get vaccinated little, moderately and highly (AOR=4.3, 95% CI 1.77 to 10.4), (AOR=20, 95% CI 8.5 to 47) and (AOR=147, 95% CI 55 to 392), respectively, was significantly associated with willingness to take the vaccine. Moreover having close family and friends who want them to get a COVID-19 vaccine (AOR=2, 95% CI 1.2 to 3.57) and religious leaders or community leaders (AOR=1.8, 95% CI 1 to 3.1) were significant factors in the multivariable logistic regression model.

CONCLUSION

This study found that COVID-19 vaccine acceptance was low in the Somali region. Factors positively linked to one's willingness to get vaccinated included the belief that it protects others, personal desire for vaccination and support from family, friends, community and religious leaders.

Understanding caregivers' decision to vaccinate childhood cancer survivors against COVID-19

BACKGROUND

Vaccination against COVID-19 is recommended for childhood cancer survivors (CCS). This study aimed to identify antecedents contributing to caregivers' decisions to vaccinate CCS aged 5-17 years against COVID-19 by applying the Theory of Planned Behavior.

METHODS

Participants in this cross-sectional study completed an online survey assessing caregiver attitudes, subjective norms, perceived behavioral control, intention to vaccinate CCS, CCS vaccination status, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Surveys were completed between May and June 2022 following approval for the emergency use of COVID-19 vaccines among children aged ≥5 years in the U.S. Data were analyzed using unadjusted linear regressions and structural equation modeling.

RESULTS

Participants were caregivers (n = 160, 87.5% biological mothers, 75.6% white/non-Hispanic) of CCS (n = 160, 44.4% female, mean (M) = 12.5 years old, M = 8.0 years off treatment). 70.0% (n = 112) of caregivers and 53.8% (n = 86) of CCS received a COVID-19 vaccine. Over one-third (37.5%) of caregivers reported disagreement or indecision about future COVID-19 vaccination for the CCS. Caregivers' intention (β = 0.962; standard error [S.E.] = 0.028; p < 0.001) was highly related to CCS vaccination status. Attitudes (β = 0.568; S.E. = 0.078; p < 0.001) and subjective norms (β = 0.322; S.E. = 0.062; p < 0.001) were associated with intention. Higher frequency of COVID-19 information-seeking (β = 0.313; S.E. = 0.063; p < 0.001) and COVID-19 health literacy (β = 0.234; S.E. = 0.059; p < 0.001) had a positive indirect effect on intention through attitudes and subjective norms.

CONCLUSIONS

Caregivers' vaccination intentions for minor CCS are highly related to vaccination behavior and shaped by attitudes, subjective norms, COVID-19 health literacy, and frequency of COVID-19 information-seeking. Promoting tailored communication with caregivers of CCS and encouraging them to review reputable sources of information can address their vaccine hesitancy.

Hybrid health regimes: Access to primary care physicians and COVID-19 vaccine uptake across municipalities in Romania

This study analyses COVID-19 vaccine uptake at the municipal level in Romania using the global health regimes and vaccine hesitancy perspectives. Our spatial regression (SARAR-het Durbin) shows that the number of primary care physicians is a significant predictor of vaccine uptake, and municipalities with higher access to the labour market have higher vaccination rates. We provide a historical perspective to demonstrate that the current health regime in Romania is a hybrid of internationalist and global health regimes, with socialist investments affecting labour participation, education, poverty, and vaccination rates. Our findings highlight the impact of regional disparities and partial privatization of the health system.

Can psychological distress account for the associations between COVID-19 vaccination acceptance and socio-economic vulnerability?

Socially disadvantaged individuals and communities consistently showed lower COVID-19 vaccination acceptance. We aimed to examine the psychological mechanisms that could explain such vaccination disparities. This study used data from serial population-based surveys conducted since the COVID-19 vaccination programme being launched in Hong Kong (N = 28,734). We first assessed the correlations of community-level and individual-level social vulnerability with COVID-19 vaccination acceptance. Structural equation modelling (SEM) was then conducted to test whether psychological distress measured by PHQ-4 can account for the associations between participants' socio-economic vulnerability and COVID-19 vaccination acceptance. The third part analysis examined whether perceived negativity of vaccine-related news and affect towards COVID-19 vaccines accounted for the association between psychological distress and COVID-19 vaccination. Communities with higher social vulnerability scores and participants who had more vulnerable socio-economic status showed lower COVID-19 vaccination acceptance. Individuals with more vulnerable socio-economic status reported higher psychological distress, which lowered COVID-19 vaccination acceptance. Furthermore, higher psychological distress was associated with lower vaccination acceptance through its psychological mechanisms of processing vaccine-related information. We proposed a renewed focus on tackling psychological distress rather than merely increasing vaccine accessibility in more socio-economic-disadvantaged groups for promoting COVID-19 vaccination acceptance.

Healthcare Worker Characteristics Associated with SARS-CoV-2 Vaccine Uptake in Ireland; a Multicentre Cross-Sectional Study

The prevention of SARS-CoV-2 acquisition and transmission among healthcare workers is an ongoing challenge. Vaccination has been introduced to mitigate these risks. Vaccine uptake varies among healthcare workers in the absence of vaccine mandates. We investigated engagement with SARS-CoV-2 vaccination among healthcare workers and identified characteristics associated with lower vaccine uptake. This multi-site cross-sectional study recruited n = 1260 healthcare workers in both clinical and non-clinical roles over a three-month period from November 2022. Participants reported their engagement with the primary SARS-CoV-2 vaccination programme and subsequent booster programmes, as well as providing demographic, occupational and personal medical history information. Multivariable linear regression identified characteristics associated with vaccine uptake. Engagement with vaccination programmes was high, with 88% of participants receiving at least one booster dose after primary vaccination course. Younger age and female sex were associated with reduced vaccine uptake. Healthcare workers in non-clinical roles also had reduced vaccine uptake. These findings should inform vaccination strategies across healthcare settings and target populations with reduced vaccine uptake directly, in particular young, female, and non-clinical healthcare workers, both for SARS-CoV-2 and other healthcare-associated vaccine-preventable infections.

Socioeconomic Inequalities in COVID-19 Vaccine Hesitancy and Uptake in Greece and Cyprus during the Pandemic

Despite the rigorous investigation of the phenomenon of vaccine hesitancy and refusal during the COVID-19 pandemic, the socioeconomic determinants of this phenomenon remain poorly investigated on a global scale. Following proportional quota sampling, we conducted a population-based cross-sectional study. We recruited participants on-site and online from different settings, regions, and socioeconomic strata in two Eastern Mediterranean populations, Greece and Cyprus. Our approach provided a nationwide sample (n = 576) approaching the adult population structure of the two countries, with a slight underrepresentation of men and older people. Our results indicate clear socioeconomic differences in vaccine hesitancy and vaccination coverage, consistent with wider social inequalities in health. In particular, we reveal a clear socioeconomic gradient characterized by lower vaccine hesitancy and higher vaccination coverage, with increasing educational attainment and income. Additionally, participants residing in semi-urban areas show higher vaccine hesitancy and have lower vaccination coverage than those residing in urban and rural areas. Our results could inform Public Health approaches aiming to tackle the alarming phenomenon of vaccine hesitancy by enabling the targeting of population groups who are particularly vaccine-hesitant, rendering such approaches more targeted and effective while at the same time reducing inequalities in the control and prevention of infectious diseases.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Vaccine Hesitancy in College Students

(1) Background: Following the COVID-19 pandemic, vaccine hesitancy has become an increasingly important topic and has created significant concerns in public health. It is important to explore vaccine hesitancy among college students as they have been identified to be a high-risk group for COVID-19 transmission. This study aims to investigate COVID-19 vaccine hesitancy in college students on a midsized midwestern university campus. (2) Methods: Data were collected from 311 undergraduate and graduate college students during June and July 2021. Participants completed a survey on COVID-19 vaccine behaviors, perceptions, and opinions. Quantitative and qualitative analysis was performed to identify vaccine hesitancy and influencing factors in the student population. (3) Results: The results of this study demonstrated significant relationships between older and younger undergraduate students (OR > 1, p < 0.05), students who received a yearly influenza vaccine and those that did not (p < 0.05), and students who had a previous COVID-19 infection and those that did not (OR > 1, p < 0.05). We also determined a significant difference between some racial/ethnic groups and vaccine hesitancy status. (4) Conclusions: COVID-19 vaccine hesitancy exists on college campuses, and is influenced by age and student status, influenza vaccination status, previous COVID-19 infection, and race/ethnicity.

The Impact of Meso-Level Factors on SARS-CoV-2 Vaccine Early Hesitancy in the United States

The extant literature on the U.S. SARS-CoV-2 virus indicates that the vaccination campaign was lagging, insufficient, and uncoordinated. This study uses the spatial model to identify the drivers of vaccine hesitancy (in the middle of the pandemic), one of the critical steps in creating impactful and effective interventions to influence behavioral changes now and in the future. The applied technique accounted for observed and unobserved homogeneity and heterogeneity among counties. The results indicated that political and religious beliefs, quantified by Cook's political bipartisan index and the percentage of the population affiliated with the main Christian groups, were the main drivers of the SARS-CoV-2 vaccine hesitancy. The past vaccination experience and other variables determining the demand and supply of vaccines were also crucial in influencing hesitancy. The results imply that vaccination campaigns require engaging community leaders at all levels rather than depending on politicians alone and eliminating barriers to the supply and demand of vaccines at all levels. Coordination among religious and community leaders would build a practical institutional arrangement to facilitate (rather than frustrate) the vaccination drives.

Factors associated with COVID-19 vaccine uptake among foreign migrants in China

Background/Purpose

The COVID-19 outbreak created unique policy challenges for vaccinating special groups like migrants. As part of sustainable development goals, the equitable distribution of the COVID-19 vaccine can contribute to ensuring health for all. This study examined COVID-19 vaccine uptake among foreign migrants in China based on sociodemographics, cultural beliefs, past vaccine behaviors, and psychosocial factors.

Design

An online cross-sectional survey was conducted among foreign migrants in mainland China via social media platforms from 21 November through 20 December 2021. Bivariate (unadjusted odd-ratio) and multivariate logistic regression analyses were performed to establish the correlates of COVID-19 vaccine uptake.

Result

Surveyed foreign migrants that are culture neutral (AOR: 2.5, CI: 95%, 1.02-5.90, p = 0.044), willing to pay for vaccination (AOR: 2.27, CI: 95%, 1.18-3.98, p = 0.012), believe in vaccine efficacy (AOR: 3.00, CI: 95%, 1.75-5.16, p < 0.000), have poor psychological health (AOR: 1.96, CI: 95%, 1.14-3.38, p = 0 0.014), and have higher perceived seriousness of COVID-19 (AOR: 2.12, CI: 95%, 1.26-3.57, p = 0.005) are more likely to receive COVID-19 vaccine. Those migrants with a history of declining vaccination (AOR: 0.34, CI: 95%, 0.18-0.65, p = 0.000) and middle-income earners $1701-3500 (AOR: 0.43, CI: 95%, 0.23-0.82, p = 0.010) are less likely to receive the COVID-19 vaccine.

Conclusion

This study brings a unique perspective to understanding vaccine behavior among international migrants in China. There is an urgent call from the World Health Organization and countries for complete vaccination and efforts to improve vaccine coverage. However, fewer studies have been conducted globally on the vaccination of migrant populations. The current study provides empirical information to increase the knowledge of the correlates of vaccine behavior among immigrants in countries around the globe. Future studies should conduct cross-country comparisons to understand the factors associated with increasing vaccination rates among immigrant populations to formulate a strong policy to increase vaccine coverage among immigrant populations across countries.

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

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

COVID-19 Vaccine Perceptions Survey for Real-Time Vaccine Outreach in Marin County, California

BACKGROUND

Understanding and addressing coronavirus disease 2019 (COVID-19) vaccine hesitancy is crucial to informing vaccination outreach strategies and achieving high vaccination coverage. Marin County, California, United States, has a history of vaccine hesitancy regarding childhood vaccinations required for school entry.

OBJECTIVES

We aimed to describe and address COVID-19 vaccine hesitancy in Marin County to inform outreach and messaging. Our objectives were to identify subgroups with high COVID-19 vaccine hesitancy early in distribution, better understand local concerns and feedback about the COVID-19 vaccine distribution process, and inform tailored vaccine messaging to increase vaccination confidence and coverage.

METHODS

The survey, which was administered from January 3 to May 10, 2021, queried demographics, vaccine acceptance, reasons for hesitancy, and reasons for acceptance. Open-ended questions were used for respondents to report additional reasons for hesitancy and for general feedback about the vaccine distribution process. We conducted quantitative and qualitative analyses stratified by COVID-19 vaccine acceptance to identify subgroups with high hesitancy. Results were shared weekly in real-time with leadership and key community partners working on vaccine outreach.

RESULTS

Among the 5,618 survey responses, there were differences in vaccine hesitancy by sociodemographic characteristics with the highest hesitancy reported among subgroups identifying as Black/African American and young adult, and within the lowest family income grouping. The most common reason for vaccine hesitancy was "uncertain about the side effects of the vaccine" (67.3% endorsement) and responses varied by race and ethnicity. Qualitative data revealed equity-related, vaccine distribution, and vaccine access themes that were not present in structured responses. Vaccine hesitancy survey results were paired with vaccination coverage and COVID-19 case data to inform tailored outreach strategies and priorities week-to-week.

CONCLUSIONS

Marin County had some of the highest COVID-19 vaccination rates in the United States during the pandemic and met equity goals aimed at ensuring vulnerable populations received vaccinations. Presenting real-time survey findings with leadership and key community partners informed a timely and tailored COVID-19 vaccine outreach and delivery strategy.

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

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

The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort

BACKGROUND

The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined.

OBJECTIVE

We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort.

METHODS

A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)-a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years).

RESULTS

The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11-year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families.

CONCLUSIONS

This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity.

Lessons from COVID'S Vaccination: External-Internal Frictions and Efficiency

This paper explores some economic variables that determine the emerging of new COVID-19 variants and the determinants of vaccination advances in 108 countries during a quarterly period from March 2020 to March 2022. We found that more people being fully vaccinated and more education (measured as schooling years) decrease the probability of the emergence of new COVID-19 variants, but more crowded cities and higher percentages of urban population increase that probability. Furthermore, we found that the percentage of fully vaccinated people depends positively on the country's preparation to respond to a health crisis, educational levels, and the index of economic complexity (which measures how diverse in the production of goods and services a country is and the level of its infrastructure), and it depends negatively on the percentage of rural populations (which makes vaccination more difficult).

Rural-Urban Disparities in Vaccine Hesitancy among Adults in South Tyrol, Italy

BACKGROUND

The demographic determinants of hesitancy in Coronavirus Disease-2019 (COVID-19) vaccination include rurality, particularly in low- and middle-income countries. In the second year of the pandemic, in South Tyrol, Italy, 15.6 percent of a representative adult sample reported hesitancy. Individual factors responsible for greater vaccination hesitancy in rural areas of central Europe are poorly understood.

METHODS

A cross-sectional survey on a probability-based sample of South Tyrol residents in March 2021 was analyzed. The questionnaire collected information on sociodemographic characteristics, comorbidities, COVID-19-related experiences, conspiracy thinking, and the likelihood of accepting the national vaccination plan. A logistic regression analysis was performed.

RESULTS

Among 1426 survey participants, 17.6% of the rural sample (n = 145/824) reported hesitancy with COVID-19 vaccination versus 12.8% (n = 77/602) in urban residents (p = 0.013). Rural residents were less likely to have post-secondary education, lived more frequently in households with children under six years of age, and their economic situation was worse than before the pandemic. Chronic diseases and deaths due to COVID-19 among close relatives were less frequently reported, and trust in pandemic management by national public health institutions was lower, as was trust in local authorities, civil protection, and local health services. Logistic regression models confirmed the most well-known predictors of hesitancy in both urban and rural populations; overall, residency was not an independent predictor.

CONCLUSION

Several predictors of COVID-19 vaccine hesitancy were more prevalent in rural areas than in urban areas, which may explain the lower vaccine uptake in rural areas. Rurality is not a determinant of vaccine hesitancy in the economically well-developed North of Italy.