Did Italy Really Need Compulsory Vaccination against COVID-19 for Healthcare Workers? Results of a Survey in a Centre for Maternal and Child Health

Profiling vaccine hesitancy in nursing to tailor public healthcare policies: A cross-sectional international study

INTRODUCTION

Vaccine hesitancy is a complex issue of global concern. As nurses play a vital role in delivering patient care and shaping public opinions on vaccines, interventions to address vaccine hesitancy in nursing are imperative. As such, identifying profiles of characteristics and attitudes contributing to hesitancy may help identify specific areas of focus to target tailored global vaccination uptake campaigns. The purpose of this study was to profile the characteristics and attitudes contributing to hesitancy toward COVID-19 and Influenza vaccines in the nursing community.

DESIGN

This multisite, cross-sectional study recruited 1967 registered nurses and 1230 nursing students from the United Kingdom, Finland, and Italy between March and September 2023.

METHODS

Data collection involved an online survey adopting the Vaccination Attitudes Examination (VAX) Scale, the Bergen Social Media Addiction Scale, and questions pertaining to sociodemographic and occupational characteristics. A k-means cluster analysis was used to identify various clusters of hesitancy based on the VAX Scale. One-way ANOVA and chi-square tests were used to identify significant differences in sociodemographic characteristics, occupational factors, vaccination attitudes, and social media usage between the clusters.

RESULTS

Three distinct clusters were identified. Profile A showed high vaccine confidence, profile B displayed slight hesitancy, and profile C reported high levels of hesitancy. In profile C, higher levels of vaccine hesitancy were identified in younger, less experienced nurses with lower educational attainment. While older nurses with higher educational attainment, who were in senior roles, were more vaccine-confident and had a consistent history of accepting the Influenza and COVID-19 vaccinations (profile A). The study found Italian nurses highly hesitant (profile C), British nurses highly confident (profile A), and Finnish nurses evenly distributed between confident, slightly hesitant, and highly hesitant (profiles A, B, and C, respectively). In addition, more frequent usage of Instagram and TikTok was associated with vaccine hesitancy (profiles B and C), and LinkedIn and X were more common among vaccine-confident individuals (profile A).

CONCLUSIONS

This study has identified specific sociodemographic and occupational factors that are related to vaccine hesitancy in an international sample of nurses. Additionally, attitudes contributing to hesitancy were identified, with worries about unforeseen future effects of the vaccine being identified as a critical attitude that may undermine confidence and increase hesitancy in nursing. This study also sheds light on the influence that social media platforms have on vaccine hesitancy and, as such, indicates which platforms are effective to disseminate vaccination campaigns to global nursing communities.

CLINICAL RELEVANCE

Global vaccination campaigns should focus on specific profiles and clusters to promote vaccination in the international nursing community. Empowering nurses early in their careers will help to instill positive vaccination behaviors, ensuring a sustained uptake of vaccinations throughout the individual's career and beyond, with an impact on promoting vaccination at the public health level as well.

Vaccine Hesitancy and Public Mistrust during Pandemic Decline: Findings from 2021 and 2023 Cross-Sectional Surveys in Northern Italy

This study examines vaccine agreements in South Tyrol, Italy, within distinct socio-cultural and linguistic contexts. Using data from the 2021 and 2023 "COVID-19 Snapshot Monitoring" extended surveys, we assessed changes in attitudes towards COVID-19 and other vaccinations during the second and final years of the pandemic. Multivariate logistic regression analysis was used to examine factors such as trust in institutions, language groups, and the use of complementary and alternative medicine. The representativeness of the study is supported by good participation rates, ensuring a comprehensive view of attitudes towards vaccination in the region. The results show a shift in public agreement with the national vaccination plan to 64% by 2023, from a rate of about 73% agreement in 2021 (p < 0.001). A significant decrease in trust in health authorities and a negative correlation with complementary and alternative medicine consultations were observed. The results highlight the complex nature of vaccine hesitancy in diverse regions such as South Tyrol and underline the need for targeted communication strategies and trust-building initiatives to effectively reduce hesitancy. This study provides critical insights for the formulation of public health strategies in diverse sociocultural settings.

Assessing the impact of COVID-19 passes and mandates on disease transmission, vaccination intention, and uptake: a scoping review

PURPOSE

Policymakers have struggled to maintain SARS-CoV-2 transmission at levels that are manageable to contain the COVID-19 disease burden while enabling a maximum of societal and economic activities. One of the tools that have been used to facilitate this is the so-called "COVID-19 pass". We aimed to document current evidence on the effectiveness of COVID-19 passes, distinguishing their indirect effects by improving vaccination intention and uptake from their direct effects on COVID-19 transmission measured by the incidence of cases, hospitalizations, and deaths.

METHODS

We performed a scoping review on the scientific literature of the proposed topic covering the period January 2021 to September 2022, in accordance with the PRISMA-ScR guidelines for scoping reviews.

RESULTS

Out of a yield of 4,693 publications, 45 studies from multiple countries were retained for full-text review. The results suggest that implementing COVID-19 passes tends to reduce the incidence of cases, hospitalizations, and deaths due to COVID-19. The use of COVID-19 passes was also shown to improve overall vaccination uptake and intention, but not in people who hold strong anti-COVID-19 vaccine beliefs.

CONCLUSION

The evidence from the literature we reviewed tends to indicate positive direct and indirect effects from the use of COVID-19 passes. A major limitation to establishing this firmly is the entanglement of individual effects of multiple measures being implemented simultaneously.

Better to Be Unpaid than COVID-19 Vaccinated! A Qualitative Study on Italian Nurses Suspended from Work without Salary

In Italy, from April 2021, healthcare workers were required to receive the COVID-19 vaccine; if they refused it, an immediate unpaid suspension was implemented until they received the vaccine. Although there are numerous quantitative studies on the factors that influenced vaccine hesitancy during the COVID-19 pandemic, qualitative research on the causes of vaccine refusal is still missing. This research aimed to investigate the phenomenon of nurses who refused to receive COVID-19 vaccination despite being required to do so, as well as the reasons behind their refusal. Furthermore, the actions of those who abandoned this stance were explored. This was a qualitative study involving the methodological approach of grounded theory. Twenty-four nurses were interviewed virtually via Zoom from May to July 2022. Anti-vax behavior-as emerged from nurses' experiences-was based on seven themes: (1) job satisfaction, (2) the main sources of information on COVID-19, (3) the reasons for refusing the COVID-19 vaccine, (4) the attitudes of family members toward the COVID-19 vaccine, (5) previous experience with other vaccines, (6) firm opposition to the vaccine (unvaccinated nurses), (7) reluctant acceptance (vaccinated nurses). It was shown that it is imperative for health authorities to adopt timely, documented, transparent, and consistent communication when carrying out public health campaigns, especially for 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.

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.

ChatGPT Output Regarding Compulsory Vaccination and COVID-19 Vaccine Conspiracy: A Descriptive Study at the Outset of a Paradigm Shift in Online Search for Information

BACKGROUND

Being on the verge of a revolutionary approach to gathering information, ChatGPT (an artificial intelligence (AI)-based language model developed by OpenAI, and capable of producing human-like text) could be the prime motive of a paradigm shift on how humans will acquire information. Despite the concerns related to the use of such a promising tool in relation to the future of the quality of education, this technology will soon be incorporated into web search engines mandating the need to evaluate the output of such a tool. Previous studies showed that dependence on some sources of online information (e.g., social media platforms) was associated with higher rates of vaccination hesitancy. Therefore, the aim of the current study was to describe the output of ChatGPT regarding coronavirus disease 2019 (COVID-19) vaccine conspiracy beliefs. and compulsory vaccination.

METHODS

The current descriptive study was conducted on January 14, 2023 using the ChatGPT from OpenAI (OpenAI, L.L.C., San Francisco, CA, USA). The output was evaluated by two authors and the degree of agreement regarding the correctness, clarity, conciseness, and bias was evaluated using Cohen's kappa.

RESULTS

The ChatGPT responses were dismissive of conspiratorial ideas about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins labeling it as non-credible and lacking scientific evidence. Additionally, ChatGPT responses were totally against COVID-19 vaccine conspiracy statements. Regarding compulsory vaccination, ChatGPT responses were neutral citing the following as advantages of this strategy: protecting public health, maintaining herd immunity, reducing the spread of disease, cost-effectiveness, and legal obligation, and on the other hand, it cited the following as disadvantages of compulsory vaccination: ethical and legal concerns, mistrust and resistance, logistical challenges, and limited resources and knowledge.

CONCLUSIONS

The current study showed that ChatGPT could be a source of information to challenge COVID-19 vaccine conspiracies. For compulsory vaccination, ChatGPT resonated with the divided opinion in the scientific community toward such a strategy; nevertheless, it detailed the pros and cons of this approach. As it currently stands, the judicious use of ChatGPT could be utilized as a user-friendly source of COVID-19 vaccine information that could challenge conspiracy ideas with clear, concise, and non-biased content. However, ChatGPT content cannot be used as an alternative to the original reliable sources of vaccine information (e.g., the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]).

Preventable Disease, the Case of Colorado: School District Demographics and Childhood Immunizations

The objective of this study was to evaluate the impact of selected sociodemographic factors on childhood vaccination hesitancy and to define their role according to specific exemptions. This population-based cohort study utilized vaccination rate and sociodemographic data from 1st to 12th grade from 2017 to 2021 for all school districts in Colorado. Data included immunization status and exemptions for each vaccine, race, ethnicity, and free and reduced meal status. Data were evaluated through dimensional analysis and Generalized Linear Mixed Models. School districts with a higher representation of White students had lower immunization rates and use more personal exemptions while school districts with larger Hispanic populations and higher proportions of free and reduced lunches had higher vaccination rates and used more religious exemptions. Black and Pacific Islander populations had higher rates of incomplete vaccination records while Asian American population displayed increased vaccination compliance. Colorado is a robust example of how socioeconomic and cultural differences are important factors with a direct influence on vaccination rates. Future childhood vaccination campaigns and legislation should consider complex socioeconomic and cultural factors.

Vaccines Administration in the Perspective of Patient Safety and Quality of Healthcare: Lesson from the Experience of an Italian Teaching Hospital for Pandemic Preparedness

The development and administration of vaccines against COVID-19 was a key element in the fight against the pandemic, as it protected health systems and helped restore global economies. National implementation plans and vaccination strategies for COVID-19 vaccines ensured the immunization of large segments of the population in the shortest time. However, even before the start of the vaccination campaign, it was clear to decision-makers that the usual methods of vaccination were not suitable. The aim of this report is to share the experience of an Italian teaching hospital in the organisation of spaces and activities of healthcare workers to realise a safe vaccination campaign. An in-depth analysis of how the vaccination campaign was organised could be useful to understand strengths and weaknesses learnt from this experience and plan an effective, efficient, and resilient response to future pandemics right away. The adoption of a systemic clinical risk management (SCRM) could guarantee healthcare organizations a more adequate and resilient response in an ethics of a job well done perspective, allowing them to maintain high patient safety standards regardless of the contingent situation for which safety first should be the motto of a disaster response plan.