Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study

Global disparities in COVID-19 vaccine booster dose (VBD) acceptance and hesitancy: An updated narrative review

The global deployment of COVID-19 vaccine booster dose (VBD) has been recognized as a promising therapeutic alliance to provide repeated immunity against the arrival of new variants. Despite scientific evidence supports the effectiveness of periodic doses, COVID-19 vaccine booster reluctance continues to thrive. This narrative review aimed to examine global COVID-19 vaccine booster dose (VBD) acceptance and summarize an up-to-date assessment of potential antecedents associated with VBD acceptance. A comprehensive search was performed in several reputable databases such as Medline (via PubMed), Scopus, Google scholar, and Web of Science from June 10th, 2023, to August 1st, 2023. All relevant descriptive and observational studies on COVID-19 VBD acceptance and hesitancy were included in this review. A total of fifty-eight (58) studies were included, with Asia representing the highest count with thirty-one (53%) studies, Europe with eleven (19 %), the United States with nine (16 %), and other regions (Africa and multi-ethnic) with seven (12 %). Worldwide, the pooled COVID-19 VBD acceptance rate was 77.09 % (95 % CI: 76.28-78.18), VBD willingness (n) = 164189, and the total sample (N) = 212,990. The highest and the lowest VBD acceptance rate was reported in Europe and American regions, respectively, 85.38 % (95 % CI: 85.02-85.73, (n) = 32,047, (N = 37,533) vs. 66.92 % (95 % CI: 66.56-67.4), (n) = 29335, (N) = 43,832. However, Asia and multi-ethnic areas reported moderately high VBD acceptance rate 79.13 % (95 % CI: 78.77-79.23, (n) = 93,994, (N) = 11,8779) and 72.16 % (95 % CI: 71.13-72.93, (n) = 9276, (N) = 12,853), respectively. The most common and key antecedents of COVID-19 VBD acceptance and hesitancy across the countries were "equal safety", "efficacy", "effectiveness", "post-vaccination side effects", "community protection" "family protection", "risk-benefit ratio", "booster necessity", "trust", and "variants control". Disparities in the uptake of COVID-19 VBD were observed globally, with the highest rates found in Europe, and the lowest rates in American regions. Multiple potential antecedents including safety, efficacy, and post-vaccination side effects were associated with VBD acceptance and hesitancy.

Predicting the intention to receive the COVID-19 booster vaccine based on the health belief model

COVID-19 vaccine boosters are recommended because the protection provided by previous doses eventually decreases, posing a threat to immunity. Some people, however, remain hesitant or unwilling to get vaccinated. The present study sought to investigate factors associated with the intention to receive the COVID-19 booster vaccine based on (1) the constructs of the Health Belief Model, and (2) trust in healthcare workers and science. A sample of 165 adults with two doses of the COVID-19 vaccine were recruited using convenience sampling. Data was collected using an online survey from November 2021 to January 2022. The survey included questions about participants' socio-demographic details, health beliefs, trust, history of COVID-19 vaccination, and the intention to receive a third dose of the COVID-19 vaccine. Ordinal logistic regression analysis showed that higher perceived benefits, severity, and trust in healthcare workers, and lower perceived barriers predicted higher willingness to get a third dose of the vaccine whereas perceived susceptibility and trust in science did not. Understanding the factors and health beliefs that underlie vaccine hesitancy are vital when developing effective interventions with the aim of increasing uptake of COVID-19 booster vaccines.

Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations

RATIONALE

Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes.

OBJECTIVE

The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations.

METHOD

We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles.

RESULTS

The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions.

CONCLUSIONS

While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.

From Archipelago to Pandemic Battleground: Unveiling Indonesia's COVID-19 Crisis

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to countries worldwide, including Indonesia. With its unique archipelagic geography consisting of more than 17,000 thousand islands, Indonesia faces unique complexities in managing the spread of the virus. Based on existing literature, this review article elaborates on key issues that have shaped Indonesia's COVID-19 response. The article begins by examining the early stages of the COVID-19 pandemic in Indonesia, along with the implementation of various preventive measures and the impact of the virus on public health. This article examines how Indonesia's socio-economic factors have generally influenced its healthcare system and further delves into the COVID-19 response strategies implemented by the Indonesian government and public health authorities as well as overall crisis preparedness. It discusses the actions taken to control the spread of the virus, including testing strategies and vaccination efforts. The difficulties encountered in implementing these measures are presented. In conclusion, this review article provides a comprehensive understanding of the COVID-19 crisis in Indonesia, covering facts on multiple dimensions ranging from the timeline of the pandemic to vaccination efforts, epidemiology, socio-economic implications, testing strategies, mobility patterns, public holidays, the impact of working from home, and the utilization of complementary and alternative medicine in addition to the standard of care for COVID-19. The insights gained from this article can complement future strategies for pandemic management and response in Indonesia and other countries facing similar challenges.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy

Background

Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML.

Methods

A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs).

Results

The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine.

Conclusions

According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Acceptance of COVID-19 vaccine booster dose among the people of Bangladesh: A cross-sectional study

Vaccine booster dose (VBD) provides a potential therapeutic alliance in preventing breakthrough infection and new variant's arrival while preserving long-lasting host immunity. This study aimed to analyze COVID-19 VBD willingness and identified the key determinants of VBD acceptance among the general people of Bangladesh. This survey-based study applied a quantitative research paradigm. A validated, anonymous, and multi-item questionnaire was adopted through a theoretical review of pertinent literature on the topic. Data were collected between August 2022─October 2022, and sampling was done randomly. A total of 704 individuals were invited via face-to-face interview approach; however, 13.8 % of them declined to give consent, which resulted in the participation of 607 potential respondents. The main outcome measure was COVID-19 VBD acceptance willingness. Binary logistic regression analysis was conducted to rationalize the study's objectives. The pooled COVID-19 booster vaccine acceptance rate was 70.0 % (95 % confidence Interval [CI]: 67─73) among Bangladeshi people. An analysis of binary logistic regression revealed that, out of 14 potential factors, "efficacy", "repeated immunity", "communication", and "trust" showed highly significant positive association (adjusted odds ratio [aOR ] = 2.151 95 % CI: 1.391─ 3.508, aOR = 2.033 95 % CI: 1.299─ 3.181, and aOR = 2.552 95 % CI: 1.557─4.183 respectively, p<0.01), and "equal safety", "risk-benefit ratio" and "community protection" had significant positive association (aOR = 1.739 95 % CI: 1.070─2.825, aOR = 1.712 95 % CI: 1.116─2.627, and aOR = 1.628 95 % CI: 1.395─0.998, p<0.05) with VBD acceptance. However, post-vaccination "side effects" showed significant negative (aOR = 0.393 95 % CI: 0.237─0.674, p<0.01) associations with VBD acceptance. The odds of accepting the COVID-19 vaccine booster was found 1.26, and it was found insignificant (p>0.05) in the Chi-squared test. Bangladeshi people expressed a moderately high level response to COVID-19 VBD acceptance. A positive attitude towards the COVID-19 VBD is an outcome of this study, regardless of the circumstances, as far as safety, efficacy, perceived health benefits, communication, trust, and community resistance are concerned. Post-vaccination side effects fear was the primary reason for booster dose skepticism as well as a barrier to administering booster shots. The confidence in COVID-19 VBD will be boosted when mass people are effectively communicated and vaccine's data become more available publicly.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

Assessing COVID-19 Vaccine Booster Hesitancy Using the Modified 5C Scale in Zhejiang Province, China: A Cross-Sectional Study

Following the rollout of a booster campaign to promote immunity against COVID-19 in China, this study aimed to assess booster hesitancy among adults who were fully vaccinated with primary doses across Zhejiang Province. Firstly, the modified 5C scale developed by a German research team was assessed for reliability and validity via a pre-survey in Zhejiang Province. Then, a 30-item questionnaire was established to conduct online and offline surveys during 10 November to 15 December 2021. Demographic characteristics and information on previous vaccination experience, vaccine type of primary doses, attitudes towards booster doses and awareness of SARS-CoV-2 infection were collected. Chi-square tests, pairwise comparison and multivariate logistic regression were performed in data analysis. In total, 4039 valid questionnaires were analyzed, with booster hesitancy of 14.81%. Dissatisfaction with previous vaccination experience of primary doses (ORs = 1.771~8.025), less confidence in COVID-19 vaccines (OR = 3.511, 95%CI: 2.874~4.310), younger age compared to the elderly aged 51-60 years old (2.382, 1.274~4.545), lower education level (ORs = 1.707~2.100), weaker awareness of social responsibility of prevention and control of COVID-19 (1.587, 1.353~1.859), inconvenience of booster vaccination (1.539, 1.302~1.821), complacency regarding vaccine efficacy as well as self-health status (1.224, 1.056~1.415) and excessive trade-offs before vaccination (1.184, 1.005~1.398) were positively associated with booster hesitancy. Therefore, intelligent means should be strengthened to optimize vaccination services. More influential experts and other significant figures should be supported to promote timely evidence-based information via various media platforms to reduce public hesitancy and increase booster uptake.

A Systematic Review on Sociodemographic, Financial and Psychological Factors Associated with COVID-19 Vaccine Booster Hesitancy among Adult Population

Background: While considerable evidence supports the safety and efficacy of COVID-19 vaccines, a sizable population expresses vaccine hesitancy. As per the World Health Organization, vaccine hesitancy is one of the top 10 hazards to global health. Vaccine hesitancy varies across countries, with India reporting the least vaccine hesitancy. Vaccine hesitancy was higher toward COVID-19 booster doses than previous shots. Therefore, identifying factors determining COVID-19 vaccine booster hesitance (VBH) is the sine qua non of a successful vaccination campaign. Methodology: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 standards. A total of 982 articles were pooled from Scopus, PubMed and Embase, while 42 articles that addressed the factors of COVID-19 VBH were finally included for further analysis. Result: We identified factors responsible for VBH and divided them into three major groups: sociodemographic, financial, and psychological. Hence, 17 articles stated age to be a major factor for vaccine hesitancy, with most reports suggesting a negative correlation between age and fear of poor vaccination outcomes. Nine studies found females expressing greater vaccine hesitancy than males. Trust deficit in science (n = 14), concerns about safety and efficacy (n = 12), lower levels of fear regarding infection (n = 11), and worry about side effects (n = 8) were also reasons for vaccine hesitancy. Blacks, Democrats, and pregnant women showed high vaccine hesitancy. Few studies have stated income, obesity, social media, and the population living with vulnerable members as factors influencing vaccine hesitancy. A study in India showed that 44.1% of vaccine hesitancy towards booster doses could be attributed dominantly to low income, rural origin, previously unvaccinated status, or living with vulnerable individuals. However, two other Indian studies reported a lack of availability of vaccination slots, a lack of trust in the government, and concerns regarding safety as factors for vaccine hesitancy toward booster doses. Conclusion: Many studies have confirmed the multifactorial nature of VBH, which necessitates multifaceted, individually tailored interventions that address all potentially modifiable factors. This systematic review chiefly recommends strategizing the campaign for booster doses by identifying and evaluating the reasons for vaccine hesitancy, followed by appropriate communication (at both individual and community levels) about the benefits of booster doses and the risk of losing immunity without them.

Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review

As the COVID-19 pandemic continues and transitions to an endemic stage, booster vaccines will play an important role in personal and public health. However, convincing people to take boosters continues to be a key obstacle. This study systematically analyzed research that examined the predictors of COVID-19 booster vaccine hesitancy. A search of PubMed, Medline, CINAHL, Web of Science, and Scopus uncovered 42 eligible studies. Globally, the average COVID-19 booster vaccination hesitancy rate was 30.72%. Thirteen key factors influencing booster hesitancy emerged from the literature: demographics (gender, age, education, income, occupation, employment status, ethnicity, and marital status), geographical influences (country, region, and residency), adverse events, perceived benefit/efficacy, perceived susceptibility, perceived severity, prior history of COVID-19 infection, vaccination status, vaccination recommendations, health status, knowledge and information, skepticism/distrust/conspiracy theories, and vaccine type. Vaccine communication campaigns and interventions for COVID boosters should focus on factors influencing booster confidence, complacency, and convenience.

Expert review of global real-world data on COVID-19 vaccine booster effectiveness and safety during the omicron-dominant phase of the pandemic

INTRODUCTION

COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. However, the emergence of the Omicron variant and subvariants as the globally dominant strains have raised doubts about the effectiveness of currently available vaccines and prompted debate about potential future vaccination strategies.

AREAS COVERED

Using the publicly available IVAC VIEW-hub platform, we reviewed 52 studies on vaccine effectiveness (VE) after booster vaccinations. VE were reported for SARS-CoV-2 symptomatic infection, severe disease and death and stratified by vaccine schedule and age. In addition, a non-systematic literature review of safety was performed to identify single or multi-country studies investigating adverse event rates for at least two of the currently available COVID-19 vaccines.

EXPERT OPINION

Booster shots of the current COVID-19 vaccines provide consistently high protection against Omicron-related severe disease and death. Additionally, this protection appears to be conserved for at least 3 months, with a small but significant waning after that. The positive risk-benefit ratio of these vaccines is well established, giving us confidence to administer additional doses as required. Future vaccination strategies will likely include a combination of schedules based on risk profile, as overly frequent boosting may be neither beneficial nor sustainable for the general population.

Parents' willingness to vaccinate themselves and their children with the booster vaccine against SARS-CoV-2: A cross-sectional study in Puyang city, China

We aimed to investigate the hesitancy and willingness of parents to vaccinate themselves and their children with a booster dose against severe acute respiratory syndrome coronavirus 2 and related factors. We conducted a cross-sectional study in Puyang city, China. The information was collected, including demographic characteristics, willingness to receive a booster dose of coronavirus disease 2019 (COVID-19) vaccine, and attitudes and concerns toward COVID-19 and vaccines. Vaccine hesitancy was assessed in individuals completing the first two doses and booster eligible, while vaccine willingness was assessed in those completing the first two doses and not yet booster eligible. Among the participants completing two primary doses while not meeting the booster criteria, 95.4% (1465/1536) and 95.0% (1385/1458) had a willingness to a booster dose of COVID-19 vaccine for themselves and their children, respectively. Among the participants who met the booster criteria, 40.3% had vaccine hesitancy. Vaccine hesitancy and unwillingness tended to occur in people who were younger, less educated, less healthy, and with unsureness of vaccines' efficacy and adverse events (AE). The younger age of children, children in poorer health, and concern about the efficacy and AE of vaccines contributed to the participants' unwillingness to vaccinate their children. We observed a high willingness to the booster dose of COVID-19 vaccine both for the parents and their children, regardless of the eligibility to a booster dose. However, 40% of people had delayed vaccination behaviors. The promotion of scientific knowledge of vaccines' effectiveness and safety is needed, especially for people in poor health and parents with young children. Timely disclosure of AE caused by COVID-19 vaccines and proper aiding offered to people encountering AE are suggested.

Drivers of and Barriers to COVID-19 Vaccine Booster Dose Acceptance in Indonesia

Obtaining a booster dose of coronavirus disease 2019 (COVID-19) vaccine is required to maintain the protective level of neutralizing antibodies and therefore herd immunity in the community, and the success of booster dose programs depends on public acceptance. The aim of this study was to determine the acceptance of a booster dose of COVID-19 vaccine and its drivers and barriers in Indonesia. A cross-sectional survey was conducted in the provinces of Indonesia between 1 and 15 August 2022. Individuals who completed the primary series of the COVID-19 vaccine were asked about their acceptance of a booster dose. Those who refused the booster dose were questioned about their reasons. A logistic regression was used to determine the determinants associated with rejection of a booster dose of COVID-19 vaccine. A total of 2935 respondents were included in the final analysis. With no information on the efficacy and safety of the COVID-19 vaccine, 95% of respondents agreed to receive a booster dose if it were provided for free by the government. This acceptance was reduced to only 50.3% if the vaccine had a 75% efficacy with a 20% chance of side effects. The adjusted logistic regression analysis indicated that there were eight factors associated with the rejection of the booster dose: age, marital status, religion, occupation, type of the first two vaccines received, knowledge regarding the importance of the booster dose, belief that natural immunity is sufficient to prevent COVID-19 and disbelief in the effectiveness of the booster dose. In conclusion, the hesitancy toward booster doses in Indonesia is influenced by some intrinsic factors such as lack of knowledge on the benefits of the booster dose, worries regarding the unexpected side effects and concerns about the halal status of the provided vaccines and extrinsic determinants such as the effectiveness and safety of the vaccine. These findings suggest the need for more campaigns and promotions regarding the booster dose benefits to increase its acceptance.

COVID-19 Booster Vaccine Intention by Health Care Workers in Jakarta, Indonesia: Using the Extended Model of Health Behavior Theories

In Indonesia, COVID-19 vaccination hesitancy persists among health care workers (HCWs). Understanding the motives and challenges impacting HCWs’ acceptance of the booster vaccination is critical. Efforts are still needed to overcome apprehension about taking a booster dosage. This study aims to analyze the vaccine acceptance among HCWs in Jakarta using an extended, modified model of health behavior theories, namely The Health Belief Model (HBM) and The Theory of Planned Behavior (TPB). A cross-sectional survey from November 2021 to January 2022 was distributed to health care workers in Jakarta. Bivariate analysis followed by multivariate regression was used to assess factors associated with the vaccine intention and collected 1684 responses. The results have shown that the final model combining the constructs and demographic characteristics could explain 50% of the variance of intention to receive a COVID-19 booster vaccination. Moreover, anticipated regret had the most significant standardized coefficient among the constructs (β = 0.381, p < 0.001). Other significant predictors in the model were attitude (β = 0.243, p < 0.001), perceived benefits (β = 0.103, p < 0.001), subjective norms (β = 0.08, p = 0.005), and perceived susceptibility (β = 0.051, p = 0.016). The findings can be used to strategize interventions to increase vaccine uptake.

Drivers of the Intention to Receive a COVID-19 Booster Vaccine: Insights from the UK and Australia

As the global pandemic perpetuates, keeping the population vaccinated will be imperative to maintain societal protection from the SARS-CoV-2 (COVID-19) virus. However, while empirical evidence regarding predictors of the intention to receive a first COVID-19 vaccine has amassed, our understanding regarding the psychological and behavioral drivers of continued COVID-19 vaccination remains limited. In this pre-registered study (UK: AsPredicted#78370|Australia: AsPredicted#81667), factors predicting the intention to receive a COVID-19 booster vaccine were investigated in two adult samples from the UK (N = 1222) and Australia (N = 1197) that were nationally representative on factors of age, gender, and geographic location. High levels of booster intent were found (73% and 67%, respectively). Exploratory Structural Equation Modelling (ESEM) revealed three key predictors of the intention to receive a booster vaccine that emerged across both UK and Australian samples: concern regarding the COVID-19 virus, positive perceptions of the COVID-19 vaccines, and the perceived severity of side effects experienced to the last COVID-19 vaccine dose. Several additional factors (age, months since the last COVID-19 vaccine, familiarity with side effects, and regularly receiving the influenza vaccine) were present in the Australian dataset. These findings provide important evidence that targeting psychological perceptions of the COVID-19 vaccine and virus may serve to maintain participation in the COVID-19 vaccination programme, paving the way for future behavioural research in this area.

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.

The Role of Knowledge, Attitude, Confidence, and Sociodemographic Factors in COVID-19 Vaccination Adherence among Adolescents in Indonesia: A Nationwide Survey

COVID-19 vaccination in adolescents is important because the adolescent population has the highest incidence of COVID-19. This study aimed to explore the factors associated with COVID-19 vaccination adherence among Indonesian adolescents. This cross-sectional study involved 7986 adolescents, polled through online and offline surveys conducted in six major islands of Indonesia. The online questionnaire was distributed through popular social messaging and social media platforms. Our team also contacted schools and public places to recruit participants from remote areas. In total, 7299 respondents completed the questionnaire. Binary logistic analysis revealed that higher levels of knowledge, positive attitudes, and confidence in the COVID-19 vaccine were significantly associated with higher COVID-19 vaccination adherence in adolescents. Sociodemographic factors were also significantly associated with higher adherence to vaccination programs. Meanwhile, younger age and habitation in private housing were related to lower adherence to the vaccination program. Parental factors related to adolescent compliance were education level, household income, history of infection of family or friends with COVID-19, and working status. The national authorities and stakeholders should take extensive measures to increase attitude, knowledge, confidence, and family support among adolescence through multiple channels.

Network Analysis of Well-Being Dimensions in Vaccinated and Unvaccinated Samples of University Students from Poland during the Fourth Wave of the COVID-19 Pandemic

Although numerous studies investigated the predictors of vaccination intention and decision, little is known about the relationship between vaccination and well-being. This study compares the physical and mental health dimensions among vaccinated and unvaccinated people. In a cross-sectional online survey, 706 university students from Poland (mean age of 23 years, 76% of women) participated in this study during the fourth pandemic wave (November–December 2021). Standardized questionnaires with a Likert response scale were included in the survey to measure spirituality, exposure to the COVID-19 pandemic, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, anxiety, depression, and life satisfaction. Consistent with the fuzzy-trace theory, the unvaccinated sample was younger and scored significantly lower than the vaccinated group in exposure to COVID-19, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, and depression, while higher in life satisfaction. The network analysis showed that mental health plays a crucial role in both groups, with the central influence of anxiety and stress on depression and life satisfaction. The message on vaccination to university students should focus on the benefits of vaccination in maintaining the status quo of good health and well-being. Campus prevention programs should primarily aim to reduce anxiety, stress, and negative emotions by teaching students coping strategies, relaxation techniques, and mindfulness.

First COVID-19 Booster Dose in the General Population: A Systematic Review and Meta-Analysis of Willingness and Its Predictors

The emergence of breakthrough infections and new highly contagious variants of SARS-CoV-2 threaten the immunization in individuals who had completed the primary COVID-19 vaccination. This systematic review and meta-analysis investigated, for the first time, acceptance of the first COVID-19 booster dose and its associated factors among fully vaccinated individuals. We followed the PRISMA guidelines. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL and medrxiv from inception to 21 May 2022. We found 14 studies including 104,047 fully vaccinated individuals. The prevalence of individuals who intend to accept a booster was 79.0%, while the prevalence of unsure individuals was 12.6%, and the prevalence of individuals that intend to refuse a booster was 14.3%. The main predictors of willingness were older age, flu vaccination in the previous season, and confidence in COVID-19 vaccination. The most important reasons for decline were adverse reactions and discomfort experienced after previous COVID-19 vaccine doses and concerns for serious adverse reactions to COVID-19 booster doses. Considering the burden of COVID-19, a high acceptance rate of booster doses could be critical in controlling the pandemic. Our findings are innovative and could help policymakers to design and implement specific COVID-19 vaccination programs in order to decrease booster vaccine hesitancy.