Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo’s Province, Italy: From Influenza to COVID-19

What Obstructs Health Policy Implementation? A Multi-Method Qualitative Case Study of the Delayed Deployment of Community Pharmacies in Ireland's National COVID-19 Vaccination Programme

During the COVID-19 pandemic, there were months of delay in deploying community pharmacies for the National COVID-19 Vaccination Programme in Ireland. We aimed to explore what may have accounted for this delay between 15th December 2020 (publication of policies) and 14th June 2021 (commencement of community pharmacy-based vaccination). We carried out a multi-method qualitative case study that involved engaging with 11 stakeholders, reviewing 246 documents, and conducting semi-structured interviews with 11 policy elites. Using reflexive thematic analysis, we developed three themes. The first provides evidence that the delay was, in part, due to operational barriers related to the logistical and safety aspects of the Programme. The second, on the other hand, presents a perspective that the delay was unreasonable as it was based on perceived deficits in community pharmacies. Finally, the third highlights the inability of the pharmacy profession to influence health policy due to a lack of strategic and cohesive leadership and the dominance of the medical profession. Overall, we argue that the delay can be explained by a complex interplay between technical, socio-political, institutional, and regulatory factors, underpinned by a chronic lack of strategic direction for pharmacy in the Irish health system.

Acceptance-Hesitancy of COVID-19 Vaccination and Factors Affecting It in Adults: Systematic Review Study

BACKGROUND

Despite the advent of vaccines against COVID-19, there is considerable variation in the acceptance and hesitancy towards the vaccination program across different countries. The objective of this study was to ascertain the prevalence of hesitancy and acceptance regarding the use of the vaccine against the novel coronavirus, also known as COVID-19, and to identify the factors that influence these attitudes.

MATERIALS AND METHODS

All the cross-sectional studies were retrieved from the PubMed databases, the Web of Science ISI, Scopus, and the Cochrane Library. Papers published in English between 2 November 2019 and 23 May 2023 were subjected to further assessment based on their title, abstract, and main text, with a view to ensuring their relevance to the present study.

RESULTS

Following an exhaustive investigation, 59 studies were selected for screening in this systematic review. The most frequently employed method of data collection was the online survey. The study sample comprised 59.12% women and 40.88% men, with ages ranging from 16 to 78 years. The proportion of individuals accepting the vaccine ranged from 13% to 96%, while the proportion of those exhibiting hesitancy ranged from 0% to 57.5%. The primary reasons for accepting the COIVD-19 vaccine were a heightened perception of risk associated with the virus and a general trust in the healthcare system. The most frequently cited reasons for vaccine hesitancy in the context of the ongoing pandemic include concerns about the potential dangers of the vaccines, the rapid pace of their development, the possibility of adverse effects (such as infertility or death), and the assumption that they have been designed to inject microchips.

DISCUSSION

A variety of socio-demographic factors are implicated in determining the rate of vaccine acceptance. A number of socio-demographic factors have been identified as influencing vaccine acceptance. These include high income, male gender, older age, marriage, the presence of older children who have been vaccinated and do not have chronic diseases, high education, and health insurance coverage.

CONCLUSION

Eliminating vaccine hesitancy or increasing vaccine acceptance is a crucial factor that should be addressed through various means and in collaboration with regulatory and healthcare organizations.

Are COVID-19 vaccination mandates for healthcare workers effective? A systematic review of the impact of mandates on increasing vaccination, alleviating staff shortages and decreasing staff illness

INTRODUCTION

The rapid development of COVID-19 vaccines is a cornerstone in the global effort to combat the pandemic. Healthcare workers (HCWs), being at the forefront of the pandemic response, have been the focus of vaccine mandate policies. This review aims to evaluate the impacts of COVID-19 vaccine mandates among HCWs, a critical step in understanding the broader implications of such policies in healthcare settings.

OBJECTIVE

The review seeks to synthesize available literature to contribute to greater understanding of the outcomes associated with COVID-19 vaccine mandates for HCWs including vaccine uptake, infection rates, and staffing.

METHODS

A systematic search of relevant literature published from March 2020 to September 2023 was conducted. The Newcastle-Ottawa scale was employed for quality assessment of the included articles. A total of 4,779 publications were identified, with 15 studies meeting the inclusion criteria for the review. A narrative synthesis approach was used to analyze these studies.

RESULTS

COVID-19 vaccine mandates for HCWs were broadly successful in increasing vaccine uptake in most settings. Although the penalties imposed on unvaccinated HCWs did not lead to major disruption of health services, less well-resourced areas may have been more impacted. Furthermore, there is insufficient literature on the impact of the vaccine mandate on reducing SARS-CoV-2 infection among HCWs.

CONCLUSION

COVID-19 vaccine mandates for HCWs have significant implications for public health policy and healthcare management. The findings underscore the need for tailored approaches in mandate policies, considering the specific contexts of healthcare settings and the diverse populations of HCWs. While mandates have shown potential in increasing vaccine uptake with minimal impacts to staffing, more work is needed to investigate the impacts of mandates across various contexts. In addition to these impacts, future research should focus on long-term effects and implications on broader public health strategies.

Knowledge and attitudes of German and Swiss community pharmacists towards biologicals and biosimilars - a prospective survey before and after the COVID-19 pandemic

BACKGROUND

Knowledge, attitudes and substitution laws of biosimilars are not consistent across countries. Biosimilar acceptance among patients and healthcare professionals may be suffering from gaps in knowledge and understanding about biosimilars and their regulatory approval process. Pharmacists' roles and responsibilities changed considerably during the COVID-19 pandemic. Thus, they might have gained new skills and self-confidence in counseling and substitution of biosimilars.

AIMS

To examine and compare the knowledge, perceptions and information needs of German and Swiss pharmacists regarding original biologicals and biosimilars in 2020 and 2022.

METHODS

We conducted an online survey among Swiss and German community pharmacies in February 2020 (before) and August 2022 (after the COVID-19 pandemic). Descriptive statistics were calculated and the Chi-Square test was used for comparisons among categorical variables.

RESULTS

A total of 764 pharmacists took part in the survey (390 in 2020 and 374 in 2022) with comparable demographics. The frequency of dispensing biologicals remained similar between German and Swiss pharmacists in 2020 and 2022, but the Swiss dispensation of biosimilars increased significantly in 2022 compared to 2020. Concerning the understanding of the term biosimilars, knowledge remained moderate in both countries in both years. Participants were equally familiar with the term and most felt sufficiently informed. In both countries, substitution with a biosimilar showed the least confidence of all attitudes. A third of the participants indicated correct substitution rules in their country. In both years, around 85% of the participants were highly interested in additional training on this topic.

DISCUSSION/CONCLUSION

The results indicate that similarities and differences between Germany and Switzerland regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. An influence of the pandemic is unlikely. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. Due to a rising market with many benefits but also big challenges to overcome, the topic of biosimilars should receive more attention in the future. This requires additional training for pharmacists.

Attitudes toward influenza vaccination in healthcare workers in Italy: A systematic review and meta-analysis

Healthcare workers (HCWs) are among the at-risk groups for whom influenza vaccination is strongly recommended. To assess the proportion of Italian HCWs with positive attitudes toward influenza vaccination, we conducted a systematic review of relevant literature and a meta-analysis. Our focus was on the influenza seasons from 2017/18 to 2021/22. The prevalence of favorable attitudes toward vaccination varied, ranging from 12% during the 2017/18 influenza season to 59% in the 2020/21 season. The significant increase in the 2020/21 season can be attributed to adaptations necessitated by the COVID-19 pandemic. During the 2021/22 influenza season, there was a decline in vaccination coverage (37%), likely due to the absence of a robust preventive culture. Various strategies have been employed to enhance HCWs' attitudes to achieve higher vaccination rates, but none of them have demonstrated satisfactory results. Policymakers should consider implementing a policy of mandatory vaccination to ensure elevated vaccination coverage among HCWs.

Influenza vaccination rates among healthcare workers: a systematic review and meta-analysis investigating influencing factors

Introduction

Healthcare workers risk of exposure to the influenza virus in their work, is a high-risk group for flu infections. Thus WHO recommends prioritizing flu vaccination for them-an approach adopted by >40 countries and/or regions worldwide.

Methods

Cross-sectional studies on influenza vaccination rates among healthcare workers were collected from PubMed, EMBASE, CNKI, and CBM databases from inception to February 26, 2023. Influenza vaccination rates and relevant data for multiple logistic regression analysis, such as odds ratios (OR) and 95% confidence intervals (CI), were extracted.

Results

A total of 92 studies comprising 125 vaccination data points from 26 countries were included in the analysis. The meta-analysis revealed that the overall vaccination rate among healthcare workers was 41.7%. Further analysis indicated that the vaccination rate was 46.9% or 35.6% in low income or high income countries. Vaccination rates in the Americas, the Middle East, Oceania, Europe, Asia, and Africa were 67.1, 51.3, 48.7, 42.5, 28.5, and 6.5%, respectively. Influencing factors were age, length of service, education, department, occupation, awareness of the risk of influenza, and/or vaccines.

Conclusion

The global influenza vaccination rate among healthcare workers is low, and comprehensive measures are needed to promote influenza vaccination among this population.

Systematic review registration

www.inplysy.com, identifier: 202350051.

The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.

Healthcare Workers' Attitudes towards Mandatory COVID-19 Vaccination: A Systematic Review and Meta-Analysis

BACKGROUND

COVID-19 vaccine mandates are considered a controversial public health policy both in public debate and among healthcare workers (HCWs). Thus, the objective of this systematic review is to give a deep insight into HCWs' views and attitudes towards COVID-19 vaccination mandates amid the ongoing COVID-19 pandemic.

METHODS

A systematic literature search of five databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) was conducted between July 2022 and November 2022. Original quantitative studies that addressed the attitudes of HCWs regarding COVID-19 vaccine mandates were considered eligible for this systematic review. All the included studies (n = 57) were critically appraised and assessed for risk of systematic bias. Meta-analyses were performed, providing a pooled estimate of HCWs' acceptance towards COVID-19 vaccine mandates for: 1. HCWs and 2. the general population.

RESULTS

In total, 64% (95% CI: 55%, 72%) of HCWs favored COVID-19 vaccine mandates for HCWs, while 50% (95% CI: 38%, 61%) supported mandating COVID-19 vaccines for the general population.

CONCLUSIONS

Our findings indicate that mandatory vaccination against COVID-19 is a highly controversial issue among HCWs. The present study provides stakeholders and policy makers with useful evidence related to the compulsory or non-compulsory nature of COVID-19 vaccinations for HCWs and the general population. Other: The protocol used in this review is registered on PROSPERO with the ID number: CRD42022350275.

The Willingness toward Vaccination: A Focus on Non-Mandatory Vaccinations

The Special Issue "The Willingness toward Vaccination: A Focus on Non-mandatory Vaccinations", published in the journal Vaccines, has the main aim of gathering more data on vaccine hesitancy and the willingness of individuals to receive vaccinations, particularly in the context of non-mandatory vaccines. The aim is to address vaccine hesitancy and improve vaccine coverage rates, in addition to identifying the determinants of vaccine hesitancy itself. This Special Issue garners articles that examine the external and internal factors that can influence the decision-making process of individuals regarding vaccination. Given that vaccine hesitancy is present in a significant part of the general population, it is crucial to have a better analytical understanding of the areas where hesitancy arises to determine appropriate strategies to address this issue.

Learning from the Past to Improve the Future—Vaccine Hesitancy Determinants in the Italian Population: A Systematic Review

WHO identifies vaccine hesitancy (VH) as one of the ten threats to global health. The authors bring to the international scientific community an Italian episode that offers the opportunity to renew the discussion on the extent of the VH matter. The purpose of this systematic review is to analyze the factors determining vaccine hesitancy in the Italian population, to understand its roots, and suggest potential strategies to mitigate it. A systematic review of the literature according to the PRISMA guidelines was carried out using the SCOPUS and Medline (via PubMed) databases, using the following strategy: (COVID-19 vaccines) AND (vaccination hesitancy) AND (Italy). After the selection process, 36 articles were included in this systematic review. The most frequently detected factors associated with VH in the Italian population can be grouped as vaccine-related factors, socio-cultural factors, and demographic factors. Currently, we are facing a gap between the population and science, governments, and institutions. To heal this breach, it is necessary to strengthen the trust of the population through the implementation of health communication and public education strategies, while scientific literacy must continue to support families and individuals in discerning evidence from opinions to recognize the real risks and balance them with the benefits.

Impact of COVID-19 pandemic on flu vaccine uptake in healthcare workers in Europe: a systematic review and meta-analysis

INTRODUCTION

Influenza immunization policies in Europe primarily target at-risk and vulnerable subjects. Healthcare workers (HCWs) are a key focus of vaccination campaigns. Our systematic review and meta-analysis aim to evaluate the role of the COVID-19 pandemic on influenza vaccine uptake among HCWs since the 2020/21 influenza season.

AREAS COVERED

Fourteen studies were included in the meta-analysis and systematic review, selected from scientific articles available in MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases between 1 January 2021 and 15 January 2023 The analysis revealed a significant relationship between influenza vaccine uptake and COVID-19 related determinants, such as willingness to receive COVID-19 vaccination, fear of COVID-19, and differentiating between influenza and COVID-19 symptoms (OR = 5.70; 95%CI = 2.08-15.60). Several studies reported higher vaccination coverages in the 2020/21 season compared to previous seasons, with VC values ranging from + 17% to + 38% compared to the 2019/20 season. The included studies identified a shift in HCWs' attitudes toward influenza vaccination, attributed to increased awareness due to the COVID-19 pandemic.

EXPERT OPINION

Vaccine hesitancy is common among HCWs in Europe, necessitating mutual strategies across all European countries. So far, mandatory vaccination policies have shown the most potential in achieving high and sustainable influenza vaccination rates among HCWs.

Digital Media Exposure and Health Beliefs Influencing Influenza Vaccination Intentions: An Empirical Research in China

The purpose of this study was to investigate whether/how digital media exposure influences people's intention to influenza vaccination. Through an anonymous online survey, we collected data on Chinese people's exposure to influenza and influenza vaccine information on digital media platforms and their attitudes toward influenza vaccines (N = 600). The structural equation model analysis results strongly support to the research hypotheses and the proposed model. The findings reveal three major themes: (1) digital media exposure significantly influence the susceptibility and severity of influenza. (2) After exposure to digital media, it is helpful to understand the vaccine's benefits, reduce the barriers to vaccination, and finally improve the intention to vaccination. (3) Users receive cues to action from digital media, and their vaccination intention tends to be positive. These findings explore how digital media exposure influences influenza vaccination intention and may provide insights into vaccine promotion efforts in countries. Research has shown that digital media exposure contributes to getting vaccinated against influenza.

Exploring the effectiveness of the Digital Green Certificate Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area

Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population. In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory "Digital Green Certificate" (DGC) to access workplaces for some categories considered at risk.

METHODS

We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influence of the introduction by law of the Digital Green Certificate (DGC) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022.

RESULTS

Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the DGC. The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom (Adj-OR = 2.45, 95%CIs = 1.51-3.97, p-value: < 0.001) but a lower sense of safety (Adj-OR = 0.19, 95%CIs = 0.12-0.29, p-value: < 0.001) after vaccine administration.

CONCLUSIONS

Our findings, in line with the available literature, suggest that the introduction of DGC has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy.

Awareness, knowledge and attitude toward influenza vaccination in several population groups in China: A cross-sectional study

Background

We aimed to comprehensively analyze awareness, knowledge and attitude toward influenza vaccine and the factors associated to vaccine acceptance among the young and middle-aged general population, healthcare workers, and health-related administrators in China. The factors influencing the promotion of influenza vaccination were also evaluated among healthcare workers and administrators.

Methods

This is a multicenter, cross-sectional study. General population adults, healthcare workers (HCWs), and health administrators were enrolled in seven regions across China during the 2020-2021 flu season. Data were collected via an online questionnaire, which included information request as to awareness, knowledge, and attitude toward influenza vaccination. Statistical significance set at p-values < 0.05.

Results

A total of 3,239 individuals were included in our analyses. There were gaps in consciousness to action, especially between awareness (87.1%) and knowledge (57.7%), and between willingness (57.3%) and vaccination (22.3%). The downward trends were similar in all three groups. HCW group and the health administrator group showed more positive propensity to accept influenza vaccines than the general population group. For the general population group, those with a lower educational level (lower than a bachelor's degree) were less likely to be vaccinated (aOR = 0.66, 95% CI: 0.45-0.96). For the HCW group, practitioners older than 45 years were more reluctant to be vaccinated than those under 25 years (aOR = 0.41, 95% CI: 0.19-0.86). For the health administrator group, personnel aged 26 years and above were less inclined to be vaccinated (aORs = 0.17-0.20). In all groups, people who had received influenza vaccines in the past 5 years (aOR = 1.72, 95% CI: 1.31-2.26 in general population group, 13.05, 95% CI: 7.71-22.10 in HCW group, and 19.30, 95% CI: 9.66-42.63 in health administrator group) were more likely to be vaccinated in future seasons. People who were not covered by the free program or those without awareness of the related programs were less likely to be vaccinated (aORs < 0.63). Most (70.8%) of HCWs showed intention to recommend the influenza vaccine. Clinical doctors, those who had flu shots themselves, and those who had more knowledge, were more like to make recommendations. Health administrators stated that insufficient budget resources and workforce, and low public awareness are main difficulties in the promotion of influenza vaccine.

Conclusion

The influencing factors of the attitude toward influenza vaccination vary across populations. Governments need to carry out focused vaccination promotion programs, especially for healthcare workers, to improve the coverage of influenza vaccination.

The psychometric properties and the factorial structure of COVID-19 Vaccines Acceptance scale (VAC-COVID-19) within the Arabic language in a Palestinian contex

Background

The COVID-19 Vaccines Acceptance scale (VAC-COVID-19) is an international measure designed to evaluate vaccination acceptance against the COVID-19 virus. The current scale was translated from English to Arabic and validated within the Palestinian context.

Aims

Our study aimed to test the factorial structure and the psychotic properties of the VAC-COVID-19 within the Palestinian context using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) through 484 participants selected using online method techniques.

Findings

The VAC-COVID-19 was a reliable and valid method in assessing COVID-19 vaccine acceptance among Palestinians. Results of CFA indicated a stable construct of a two-factor solution in assessing COVID-19 vaccination acceptance in a Palestinian context. (1) Reasons for not receiving the vaccination, and (2) for receiving the vaccination.

Conclusion

The VAC-COVID-19 was a valid method to assess vaccination acceptance in the Arabic language within the Palestinian context. Therefore, it is recommended to conduct similar studies with diverse samples in Palestinian society; it would be prudent to target at-risk populations needed to develop the scale and its factorial structure. The VAC-COVID-19 can be a useful measure to assess vaccination acceptance among Palestinians, enabling health providers to implement interventions to modify negative attitudes toward not receiving vaccinations.