Socioeconomic Determinants in Vaccine Hesitancy and Vaccine Refusal in Italy

Role of Individual, Social and Health Factors as Determinants of COVID-19 Vaccine Hesitancy: Results from the Second Phase of the Italian EPICOVID19 Web-Based Survey

BACKGROUND

Despite scientific breakthroughs in vaccine development, some people remain reluctant to accept the anti-SARS-CoV-2 vaccine. This study evaluates attitudes and behaviours towards the vaccine and factors associated with refusal/hesitancy at the start of Italy's vaccination campaign.

METHODS

EPICOVID19 is a two-phase observational web-based study where adult volunteers completed questionnaires in April-June 2020 and January-February 2021. Refusal/hesitancy towards the vaccine was assessed among those not yet vaccinated. We analysed factors associated with refusal/hesitancy by applying multivariate multinomial logistic regression models.

RESULTS

Among 36,820 survey participants (mean age of 51 years, 59.7% women, 63.6% highly educated), 2449 (6.7%) were against or hesitant, 4468 (12.1%) were inclined but unsure, and 29,903 (81.2%) were willing to be vaccinated. Factors positively associated with refusal/hesitancy included female sex, middle age, at-risk occupations, medium and low education, deprived status, being underweight, previous SARS-CoV-2 positivity, poor perceived health, no fear of contracting SARS-CoV-2, the fear of contaminated food and natural disasters, and low trust in science, media, government, or institutions. Low hesitancy was associated with student and retired status, overweight and obesity, moderate and high alcohol consumption, no concern about economic and working conditions, and sensitivity to climate change/environmental pollution and epidemics.

CONCLUSIONS

This survey showed that, during the first month of Italy's vaccination campaign, some individuals were reluctant to receive the anti-SARS-CoV-2 vaccine. This study highlights potential target groups for tailored communication and prevention campaigns.

Global Systematic Scoping Review of Adolescent Factors Associated With COVID-19 Vaccine Hesitancy

Although COVID-19 vaccination is recommended for adolescents aged 12-17 years, they remain one of the least commonly vaccinated age groups. Therefore, studies investigating the factors associated with vaccine hesitancy among adolescents are needed. We conducted a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards from inception to October 23, 2022, for adolescent-reported factors associated with vaccine hesitancy. Titles and abstracts of articles were screened, full-text articles were reviewed for eligibility, and eligible articles were extracted by 2 independent reviewers. Results were summarized using a narrative synthesis. The review protocol was prospectively registered in PROSPERO (CRD42022363411). Of 4,140 articles screened, 302 were selected for full-text review, 27 of which met the eligibility criteria. Most studies evaluated age (n = 20 studies) and sex (n = 21 studies) in relation to COVID-19 vaccine hesitancy, yet these were uncommonly linked with vaccine hesitancy among adolescents. Adolescents consistently reported the impact of the pandemic on social activities, social and parental norms, and a sense of communal responsibility as reasons for vaccinating. Although fewer studies (n = 18 studies) evaluated theoretical-based factors, the studies conducted showed that perceived vaccine safety and efficacy (n = 6 studies), risks from vaccination (n = 5 studies), and social and parental norms (n = 3) were consistently linked with vaccine hesitancy. To address low vaccination rates, adolescent-engaged research remains needed that considers their perspectives on COVID-19 vaccines.

The first 1000 days: the price of inequalities in high and middle-income countries

The first 1000 days of human life start from conception until the child turns 2 years of age. This is a unique period in which the foundations of a child's lifelong health are built. Disadvantaged socioeconomic circumstances and limited access to health care services can globally affect a child's health outcomes and educational and vocational potential. This article discusses health inequalities over the first 1000 days of life and possible mitigation programs. Governments and politicians should promote fairer health interventions and pediatric healthcare workers should be aware of the main health determinants to advocate for more equitable and child-focused resource allocation. Therefore, the main approaches to contrast health inequalities include cooperation between governments and public health professionals, removing barriers to accessing medical care, and raising staff awareness about health determinants. Finally, pro-equality interventions should include providing services commensurate with the level of need, in adherence to the principle of social justice. IMPACT: This review aims to elicit a detailed understanding of how inequalities affect early childhood development in different socio-economic contexts, focusing on both the short and long-term consequences. The greatest impact comes precisely from providing valuable tools for both clinicians and public health practitioners to understand and read, in daily practice, the effects produced by health determinants and health inequalities.

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.

Vaccine Beliefs Among Uninsured People Receiving Care at Free Clinics

BACKGROUND

Misinformation and vaccination hesitancy contribute to disparities in vaccination rates, particularly in under-resourced communities. This study aims to investigate perceptions and factors influencing vaccination decisions at free clinics serving diverse, under-resourced communities.

METHODS

Surveys were conducted across eight free clinics in the Greater Sacramento area, targeting uninsured or underinsured individuals. Information on demographics, sources of vaccine information, access to vaccines, vaccine perceptions, and vaccination decisions as pertaining to influenza and COVID-19 were collected on Qualtrics software. Chi-square and t-tests were used to analyze associations between demographics and vaccination rates.

RESULTS

Among 109 participants (24-82 years old), vaccination rates were found to be higher than the county average, with notable demographic variations. Contrary to initial hypotheses, men had higher vaccination rates than women, and recent immigrants exhibited higher vaccination rates than more long-term U.S. residents. A higher number of participants regarded the COVID-19 vaccine as effective than as safe, while the reverse was true for the influenza vaccine. Healthcare providers were the most trusted and influential sources for vaccine information, followed by government agencies, and then family and friends. Answers to hypothetical vaccine scenarios elicited assessments on risks and benefits.

CONCLUSION

The study provides insight into the dynamics of vaccine hesitancy and factors that play into the decision-making process in under-resourced communities, underscoring the role of trust in healthcare providers. These findings are vital for tailoring community outreach strategies to create trust, address barriers, and enhance vaccine uptake within free community clinics.

Understanding Vaccine Hesitancy: A Comparison of Sociodemographic and Socioeconomic Predictors with Health Literacy Dimensions

Vaccine hesitancy represents a global public health challenge that can diminish the effectiveness of vaccination programs. Research indicates that various sociodemographic and socioeconomic factors, along with health literacy, predict vaccine hesitancy. In this study, we analyzed data from a Slovenian health literacy survey that included 3360 adult participants. We examined the effects of sociodemographic (gender and age) and socioeconomic factors (education, economic deprivation, and self-assessed socioeconomic status), as well as different dimensions of health literacy (general, communicative, and navigational), on vaccine hesitancy. The results show that age, education, and economic deprivation are statistically significant predictors of vaccine hesitancy; younger individuals, those with lower education levels, and those experiencing greater economic deprivation express increased vaccine hesitancy. Higher levels of general and communicative health literacy are associated with lower vaccine hesitancy, while navigational health literacy was not found to be a statistically significant predictor of vaccine hesitancy.

Association between Socioeconomic Status and Vaccination Hesitancy, Reluctancy and Confidence among Asian-Americans Living in the State of New Jersey

BACKGROUD

Socioeconomic status (SES) plays a vital role in determining vaccination uptake and attitudes. Vaccine hesitancy varies among different communities, yet knowledge of vaccine attitudes among Asian-Americans is limited.

OBJECTIVE

This study aims to investigate the relationship between SES and vaccine attitudes among Asian-Americans in the State of New Jersey (NJ).

METHODS

Asian-Americans aged ≥ 18 years living in NJ were included (N = 157). SES was measured by education level, employment type, employment status, and household income. The primary outcomes were vaccine hesitancy, reluctance, and confidence for COVID-19, influenza, and pneumococcal vaccines. Descriptive and inferential statistics were performed. Multivariable logistic regression was used to identify associations between SES and vaccine hesitancy while controlling for confounders such as age, gender, birthplace, and religion.

RESULTS

Among 157 participants, 12.1% reported vaccine hesitancy. There was no statistically significant association between vaccine hesitancy and education level (p = 0.68), employment status (p = 1), employment type (p = 0.48), and household income (p = 0.15). Multivariable logistic regression modeling confirmed that none of the SES predictor variables were associated with vaccine hesitancy. However, as exploratory finding, gender was found to be a significant predictor, with males having lower odds of vaccine hesitancy than females (Adjusted OR = 0.14; p < 0.05). Confidence in influenza and pneumococcal vaccines increased during the pandemic, from 62.34% to 70.13% and from 59.2% to 70.51%, respectively. For the COVID-19 vaccine, 73.1% of participants reported having "a lot of confidence" in taking vaccine.

CONCLUSION

Most sampled Asian-Americans in NJ have high confidence in taking COVID-19 vaccines, and there is no significant association between vaccine hesitancy and SES.

Decision Regret and Vaccine Hesitancy among Nursing Students and Registered Nurses in Italy: Insights from Structural Equation Modeling

This study focused on vaccine hesitancy and decision regret about the COVID-19 vaccine among nursing students (BScN and MScN) and Registered Nurses (RNs) in Italy. The primary aim was to describe decision regret and vaccine hesitancy among these groups and to understand what influences vaccine hesitancy. Data were collected through an e-survey conducted from March to June 2024. The Decision Regret Scale and the Adult Vaccine Hesitancy Scale were employed to assess regret and hesitancy levels, assessing trust, concerns, and compliance regarding vaccination. Among the participants, 8.64% were not vaccinated. The results indicated moderate to high levels of decision regret and diverse levels of trust, concerns, and compliance with COVID-19 vaccination. Structural equation modeling revealed that decision regret significantly predicted Trust (R2 = 31.3%) and Concerns (R2 = 26.9%), with lower regret associated with higher trust and lower concerns about vaccine safety. The number of COVID-19 vaccine boosters was a significant predictor of Trust and Concerns, with more boosters associated with higher trust and lower concerns. MScN students exhibited higher Compliance compared to RNs (R2 = 2.9%), highlighting the role of advanced education. These findings suggest that addressing decision regret and providing comprehensive vaccine information could enhance trust and compliance.

Vaccine Confidence and Coverage among Medical Students at a Federal University in Brazil

BACKGROUND

Declining vaccination coverage (VC) and vaccine hesitancy among medical students are global challenges. These challenges reflect individual and logistical barriers to a sufficient adherence toward essential vaccines for healthcare professionals, as well as presenting a need for educational strategies during undergraduate training.

METHODS

This is a prospective study for evaluating VC rates, sociodemographic associations, and the vaccine confidence among medical students at a federal university in Brazil. The data collection included questionnaires and individual analyses of the participants' vaccination records.

RESULTS

A total of 237 medical students from all six years of an undergraduate program participated, of whom 124 (52.3%) had a vaccination record. Although the majority considered the vaccines to be "Completely Safe" (86.9%), the VC rates for complete vaccination schedules were relatively low, ranging from 87.9% (hepatitis B vaccine) to 3.2% (meningococcal B vaccine), including the vaccines from the National Immunization Program (NIP) and the private sector. Higher VC rates were found to occur among students in the final years of their undergraduate studies, in those from families with higher monthly incomes, and those from private secondary schools.

CONCLUSIONS

Given the low VC rates among medical students, other factors in addition to vaccine confidence may be determinants, thus highlighting the importance of reviewing policies for the inclusion of priority groups in the NIP and in implementing educational interventions during undergraduate training.

Factors Affecting Parental Intent to Vaccinate Against COVID-19 in the United States

Introduction

The topic of childhood vaccinations has become increasingly contentious, sparking debate, and creating challenging decisions for parents. This study aimed to explore the factors influencing COVID-19 vaccination decisions for parents of unvaccinated children and identify the most common reasons for not vaccinating children against COVID-19 in the U.S.

Methods

Authors analyzed data from Phase 3.7, Week 53 of the United States Census Bureau's Household Pulse Survey (N = 68,504), collected from January 4 to January 16, 2023. Standard descriptive statistics and adjusted odds ratio (aOR) were used to analyze the data.

Results

The top three reasons for vaccine hesitancy were concerns about side effects, lack of trust in the vaccine, and the perception that children in the household were not part of a high-risk group. Among respondents, nearly 87% (n = 59,363) reported receiving a COVID- 19 vaccination, and these individuals were more inclined to vaccinate their children across all age groups studied. Additionally, participants with higher levels of education (bachelor's degree or higher) were more likely to vaccinate their children against COVID-19 (aOR = 5.79; 95% CI, 5.43-6.17; p <0.001).

Conclusions

Findings from the study suggest that some parents are still concerned about the COVID-19 vaccine and are hesitant to vaccinate their children against the disease. Information and insights from this study allow for a greater understanding of how parents are making this decision nearly three years after the pandemic officially began. Further studies are needed to determine how other factors, such as geographical location, also may affect parental COVID-19 vaccination hesitancy.

An ecological analysis of socio-economic determinants associated with paediatric vaccination coverage in the Campania Region: A population-based study, years 2003-2017

Introduction

Vaccines are the most cost-effective and straightforward intervention against severe infectious diseases. However, in Europe and in Italy, paediatric vaccination coverage for certain vaccines remains suboptimal, with considerable regional differences in Italy. Vaccine coverage varies significantly due to socio-economic and organisational factors. Aim of this study was to assess the influence of the Deprivation Index, the density of General Practitioners and General Paediatricians per inhabitants on the coverage of both mandatory and non-mandatory paediatric vaccinations across local health authorities and health districts in the Campania Region for birth cohorts from 2001 to 2015.

Materials and methods

Population-based, ecological time series analysis focusing on the Campania Region, most populous region in the south of Italy. Vaccination coverage data were extracted from the regional immunization database, whilst information on the Deprivation Index and number of primary care doctors and primary care paediatricians per local health district were extracted from public health records. Univariate descriptive statistics were employed to describe study characteristics, as appropriate, whilst and mixed-effect linear regression models were employed to assess the associations between variables of interest and vaccination coverage.

Results

Overall vaccination coverage has generally increased, except for the MMR vaccine, which showed coverage fluctuations. An increase in the Deprivation Index, indicative of less favourable socio-economic conditions, was associated with decreased vaccination coverage in the 24-month age group for some mandatory vaccines (DTaP: Coef -0.97, 95% CI -1.77 | -0.17; Poliomyelitis: Coef -0.98, 95% CI -1.78 | -0.17; Hepatitis B: Coef -0.90, 95% CI -1.71 | -0.10). Moreover, areas with a greater density of General Paediatricians per inhabitants saw increased coverage for Haemophilus influenzae type b in the 6-year age group (Coef 9.78, 95% CI 1.00 | 18.56).

Conclusions

It is necessary to target public health policies to address vaccination inequalities. These efforts should include expanding vaccination campaigns, enhancing catch-up programs, and increase resource allocation in primary care settings to facilitate the role of General Practitioners and Paediatricians in fostering awareness and adherence.

Evolution and the critical role of the microbiota in the reduced mental and physical health associated with low socioeconomic status (SES)

The evolution of the gut-microbiota-brain axis in animals reveals that microbial inputs influence metabolism, the regulation of inflammation and the development of organs, including the brain. Inflammatory, neurodegenerative and psychiatric disorders are more prevalent in people of low socioeconomic status (SES). Many aspects of low SES reduce exposure to the microbial inputs on which we are in a state of evolved dependence, whereas the lifestyle of wealthy citizens maintains these exposures. This partially explains the health deficit of low SES, so focussing on our evolutionary history and on environmental and lifestyle factors that distort microbial exposures might help to mitigate that deficit. But the human microbiota is complex and we have poor understanding of its functions at the microbial and mechanistic levels, and in the brain. Perhaps its composition is more flexible than the microbiota of animals that have restricted habitats and less diverse diets? These uncertainties are discussed in relation to the encouraging but frustrating results of attempts to treat psychiatric disorders by modulating the microbiota.

Identifying characteristics that enable resilient immunisation programmes: a scoping review

OBJECTIVES

The COVID-19 pandemic highlighted the fragility of immunisation programmes and resulted in a significant reduction in vaccination rates, with increasing vaccine-preventable disease outbreaks consequently reported. These vulnerabilities underscore the importance of resilient immunisation programmes to ensure optimal performance during crises. To date, a framework for assessing immunisation programme resilience does not exist. We conducted a scoping review of immunisation programmes during times of crisis to identify factors that characterise resilient immunisation programmes, which may inform an Immunisation Programme Resilience Tool.

DESIGN

Scoping review design followed the Arksey and O'Malley framework, and manuscript reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.

DATA SOURCES

CINAHL, CENTRAL, Embase, Google Scholar, MEDLINE, PsycINFO and Web of Science and databases were searched between 1 January 2011 and 2 September 2023. Citation searching of identified studies was also performed.

ELIGIBILITY CRITERIA

We included primary empirical peer-reviewed studies that discussed the resilience of immunisation programme to crises, shocks or disruptions.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened records and performed data extraction. We extracted data on study location and design, crisis description, and resilience characteristics discussed, and identified evidence gaps in the literature. Findings were synthesised using tabulation and an evidence gap map.

RESULTS

Thirty-seven studies met the eligibility criteria. These studies captured research conducted across six continents, with most concentrated in Africa, Asia and Europe. One study had a randomised controlled trial design, while 36 studies had observational designs (15 analytical and 21 descriptive). We identified five characteristics of resilient immunisation programmes drawing on the Health System Resilience Index (Integration, Awareness, Resource Availability and Access, Adaptiveness and Self-regulation) and several evidence gaps in the literature.

CONCLUSIONS

To our knowledge, no immunisation programme resilience tool exists. We identified factors from the Health System Resilience Index coupled with factors identified through primary empirical evidence, which may inform development of an immunisation programme resilience tool.

Turkish Adaptation, Reliability, and Validity Study of the Vaccine Acceptance Instrument

This research study aimed to assess the reliability and validity of the Turkish version of the Vaccine Acceptance Instrument (VAI). The VAI is a 20-item Likert-type scale, with responses ranging across seven points. A systematic approach was followed to translate the scale into Turkish, involving translation, expert panel evaluation, back-translation, and pilot testing. The Vaccine Acceptance Instrument and a sociodemographic data form were used for data collection. The reliability of the scale was tested by test-retest analysis, and its internal reliability was examined by Cronbach's alpha test. The factor structure was examined using Exploratory Factor Analysis (EFA). Confirmatory Factor Analysis (CFA) was employed to assess the scale's fit. Overall, 229 participants were included in the study. In test-retest reliability analysis, the intraclass correlation coefficient of the scale was 0.992 (95% CI: 0.987-0.996). The Cronbach's alpha value of the scale was 0.824. A four-factor structure was determined. The model had an acceptable fit [χ2/df = 380.04/164 (2,317) p < 0.001, CFI = 0.91, GFI = 0.90, AGFI = 0.906, NFI = 0.90, RMSEA = 0.076]. The mean total VAI score was 112.71 ± 17.02. The low education level of the mother, being a housewife, and parents not having the COVID-19 vaccine were statistically significantly associated with a low scale score and low vaccine acceptance (p < 0.05). The Turkish adaptation of the VAI demonstrated satisfactory levels of validity and reliability following rigorous testing.

Highly Educated Mother's Perception of Childhood Vaccination Hesitancy in Kazakhstan: A Thematic Analysis

Background

Vaccine hesitancy among parents directly affects the child's vaccination status since they are the legal decision-makers regarding vaccinating their children. The study aimed to describe the perceptions of highly educated Kazakhstani mothers about childhood vaccination hesitancy.

Methods

The study utilized a thematic analysis to explore the mothers' perceptions. A sample of 95 participants comprehensively answered the free-text questions in an online questionnaire from January to February 2023. The analysis of the free-text responses followed a semantic thematic analysis approach. The data were coded manually.

Results

From the in-depth analysis of the data, 285 initial codes were extracted. The combination of similar meanings and concept codes led to 14 sub-themes and finally yielded four significant themes: misconceptions about childhood vaccination, fear of the effect of vaccine on children, distrust of the healthcare system, and social learning factors.

Conclusion

The perceptions of Kazakh mothers about childhood vaccination hesitancy may lead to behaviors of delaying and refusing some or all childhood vaccines. Therefore, motivational and educational strategies can be used by healthcare providers to instill trust in parents about childhood vaccines and their safety and effectiveness.

Comprehensive childhood vaccination and its determinants: Insights from the Indonesia Family Life Survey (IFLS)

BACKGROUND

Immunization is the most effective intervention for reducing morbidity and mortality rates associated with vaccine-preventable diseases. Despite the Indonesian government's inclusion of several childhood vaccinations in the national immunization program (NIP), the number of unvaccinated or partially vaccinated children remains high. This observational study aimed to determine the completeness of childhood immunization and the factors influencing it in Indonesia.

METHODS

Data were extracted from the fifth wave of the Indonesia Family Life Survey (IFLS). The sample (n = 16,236) consists of children residing in 13 provinces, representing over 80% of Indonesia's population. The difference between groups was tested using the chi-square test. Logistic regression was performed to identify the variables associated with the completeness of basic immunization. Immunization is categorized as complete when children have received all the mandatory vaccines recommended by the Ministry of Health. We examined and compared the results using complete case analysis, inverse probability weighting, and multiple imputations.

RESULTS

The highest percentages of complete vaccinations were polio, tuberculosis, and DPT. Children who live in Sumatera and Kalimantan were more likely to be fully immunized, with ORs of 0.6 (95%CI 0.48-0.74) and 0.54 (0.37-0.80), respectively. Children who live in urban areas, have mothers who received the tetanus vaccine during pregnancy, have mothers with a higher level of education and health insurance, have fathers aged 41-50, and live with a large number of family members were more likely to be fully immunized (p < 0.05).

CONCLUSION

Socioeconomic determinants were strongly correlated with the completeness of childhood vaccination in Indonesia.

Vaccine decision making in New Zealand: a discrete choice experiment

BACKGROUND

Vaccine hesitancy is a significant threat to global health. A key part of addressing hesitancy is to ensure that public health messaging prioritises information that is considered important to the public. This study aimed to examine how different vaccine characteristics affect public preferences for vaccines in New Zealand, what trade-offs they are willing to make between different vaccine characteristics, and how their preferences are affected by their vaccine-related conspiracy beliefs and COVID-19 vaccination status.

METHODS

An online discrete choice experiment (DCE) was designed to elicit individual preferences about vaccines using the 1000minds platform. Members of the general population of New Zealand aged ≥ 18 years were invited to complete the DCE. Participants were asked to indicate their preference between two options showing different combinations of vaccine characteristics. Data on sociodemographic characteristics were collected. Beliefs were measured using the vaccine conspiracy beliefs scale (VCBS) with scores ≥ 19 indicating strong vaccine-related conspiracy beliefs. The DCE was analysed using the PAPRIKA method (Potentially All Pairwise RanKings of all possible Alternatives) and preferences compared between respondents with high versus low VCBS scores and vaccinated versus unvaccinated respondents for COVID-19.

RESULTS

A total of 611 respondents from 15 regions completed the DCE. Mean (SD) age was 45.9 (14.7) years with most having had 2 or more doses of the coronavirus vaccine (86%). Mean (SD) VCBS score was 18.5 (12.4) indicating moderate vaccine-related conspiracy beliefs. Risk of severe adverse effects was the most highly valued vaccine characteristic, followed by vaccine effectiveness and duration of protection. Vaccine origin and route of administration were ranked least important. Respondents scoring high on the VCBS placed less value on the effectiveness of vaccines but greater value on development time and total number of doses (p < 0.001). COVID-19 unvaccinated respondents ranked development time and total number of doses more highly than those vaccinated respondents (p < 0.001).

CONCLUSIONS

Risk of severe adverse effects, vaccine effectiveness and duration of protection were rated by the New Zealand public as the top three most important vaccine characteristics. This information is important for informing public health messaging to promote vaccine uptake and inform vaccine decision-making.

The frequency and determinants of vaccine hesitancy among parents of preschool and kindergarten students in Edirne central district

PURPOSES

The aim of our study is to determine the frequency of vaccine hesitancy and the associated factors among parents with preschool children in a city center.

DESIGN AND METHODS

We conducted a cross-sectional study among parents of preschool children in the central district of Edirne. The cluster sampling method was applied. The data collection tools consisted of a questionnaire designed by the researchers and The Parent Attitudes about Childhood Vaccines (PACV) Scale. The correlations between vaccine hesitancy among parents factos such as the vaccine's content, adverse effects, religious beliefs, media coverage, reliance on community leaders, and the usage of complementary and alternative medical methods were examined.

RESULTS

The study group consisted of 315 individuals and the prevalence of vaccine hesitancy among participants was determined to be 13%. The mean PACV scale score of the parents was 29.76 ± 16.62. According to multivariate analyses, the odds ratios (%95 CI) of variables that were statistically significantly associated with parental vaccine hesitancy were as follows: being a mother 8.77 (1.02-75.07), vaccine side effects 2.91 (0.93-9.16), low/equal income level 6.80 (2.45-18.86), low/high income level 5.74 (1.65-20.0), religious reasons 3.33 (1.34-8.25), and media influence 9.53 (3.75-24.18).

CONCLUSION

Overall, vaccine hesitancy was observed at one in every 7 parents in the central district of Edirne province, and the main determinants of hesitancy were low-income status, media influence and religious beliefs, advers effects and being mother. Community-based intervention programs should be established to combat vaccine hesitancy.

PRACTICAL IMPLICATIONS

The PACV scale is recommended for detecting community-based vaccine hesitancy.

Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.

The COVID-19 Vaccine Conundrum: An Assessment of Vaccine Hesitancy Amongst Patients at a Federally Qualified Health Center

Background: With three COVID-19 vaccines currently authorized for use in the US, vaccine hesitancy has the potential to sabotage COVID-19 vaccination efforts and be detrimental to overall health outcomes. In order to realize the extent of vaccine hesitancy, an adequate understanding of the role that self-identified barriers and epidemiologic factors may play is timely and important. Objectives: The objectives of this study were to 1) determine if there is a relationship between vaccine hesitancy and epidemiologic factors, and 2) identify perceived patient-reported barriers associated with receiving a COVID-19 vaccine. Methods: A written questionnaire was utilized to collect data from eligible patients over a 15-week period between October 2020 and February 2021. A combination of non-parametric tests and descriptive statistics were used to analyze this data. Results: A majority of patients were either very strongly in support of (28.2%) or very strongly against (29.7%) receiving a COVID-19 vaccine. Notable findings included the comparison of patients with advanced degrees being more likely to get vaccinated (48.1%) to those without advanced degrees (38.8%) (P = .032). There was also a significant difference between races regarding their interest in receiving a COVID-19 vaccine. Blacks were much more likely to answer very strongly against receiving the vaccine (60.9%) compared to Caucasians (22.1%) and Hispanics (30.4%) (P <.001). The most reported barrier to receiving a COVID-19 vaccine was concern for side effects. Conclusion: This study provides a glimpse into possible correlations between vaccine hesitancy and epidemiologic factors as well as patient-reported barriers to receiving a COVID-19 vaccine. With widespread vaccination underway, it is imperative that we learn about and address concerns about receiving the COVID-19 vaccine to ensure community protection against this serious life-threatening infectious disease.

Maternal pertussis vaccination behavior: Psychosocial, attitudinal and organizational factors

BACKGROUND

In December 2019, the maternal pertussis vaccination (MPV) became part of the Dutch National Immunization Program. This study aims to study MPV behavior and associated psychosocial, attitudinal and organizational factors of pertussis vaccination behavior during pregnancy in the Netherlands.

METHODS

We conducted a cross-sectional survey among pregnant women and recent mothers, up to six months post-partum. The primary outcome measure of this study was MPV behavior. Associations between psychosocial, attitudinal and organizational factors and MPV behavior were assessed using univariate and multivariate binary logistic regression analysis.

RESULTS

In total 1348 participants filled out the questionnaire, including 1282 (95.1%) MPV acceptors and 66 (4.9%) MPV refusers. The most important factors associated with MPV behavior were: attitude (aOR: 10.19; 95%CI: 4.30-24.16), outcome expectations (aOR: 8.94; 95%CI: 3.60-22.21), omission bias (aOR: 0.11; 95%CI: 0.02-0.59) and physical accessibility (aOR: 7.44; 95%CI: 3.37-16.46).

CONCLUSION

Pregnant women make their decision about the MPV primarily based on attitudinal and psychosocial factors, such as outcome expectations and attitude. A combination and variation of different messages, about the advantages (effectiveness) and disadvantages (side effects) of maternal vaccination, can be used in reaching pregnant women with a positive and negative attitude about the MPV. In addition, strategies to increase MPV uptake should not only focus on providing information, but also decrease experienced practical barriers, such as poor physical accessibility, in people that are intended to receive the MPV but are not getting vaccinated.

Discretion in decision to receive COVID-19 vaccines and associated socio-economic inequalities in rates of uptake: a whole-of-population data linkage study from Australia

OBJECTIVE

In Australia, first and second compared to third dose of a COVID-19 vaccine were implemented under different policies and contexts, resulting in greater discretion in decisions to receive a third compared to first and second dose. We quantified socio-economic inequalities in first and third dose to understand how discretion is associated with differences in uptake.

STUDY DESIGN

Whole-of-population cohort study.

METHODS

Linked immunisation, census, death and migration data were used to estimate weekly proportions who received first and third doses of a COVID-19 vaccine until 31 August 2022 for those with low (no formal qualification) compared to high (university degree) education, stratified by 10-year age group (from 30 to 89 years). We estimated relative rates using Cox regression, including adjustment for sociodemographic factors.

RESULTS

Among 13.1 million people in our study population, 94% had received a first and 80% a third dose by 31 August 2022. Rates of uptake of first and third dose were around 50% lower for people with low compared to high education. Gaps were small in absolute terms for first dose, and at the end of the study period ranged from 1 to 11 percentage points across age groups. However, gaps were substantial for third dose, particularly at younger ages where the socio-economic gap was as wide as 32 percentage-points.

CONCLUSION

Education-related inequalities in uptake were larger where discretion in decisions was larger. Policies that limited discretion in decisions to receive vaccines may have contributed to achieving the dual aims of maximising uptake and minimising inequalities.

The old friends hypothesis: evolution, immunoregulation and essential microbial inputs

In wealthy urbanised societies there have been striking increases in chronic inflammatory disorders such as allergies, autoimmunity and inflammatory bowel diseases. There has also been an increase in the prevalence of individuals with systemically raised levels of inflammatory biomarkers correlating with increased risk of metabolic, cardiovascular and psychiatric problems. These changing disease patterns indicate a broad failure of the mechanisms that should stop the immune system from attacking harmless allergens, components of self or gut contents, and that should terminate inappropriate inflammation. The Old Friends Hypothesis postulates that this broad failure of immunoregulation is due to inadequate exposures to the microorganisms that drive development of the immune system, and drive the expansion of components such as regulatory T cells (Treg) that mediate immunoregulatory mechanisms. An evolutionary approach helps us to identify the organisms on which we are in a state of evolved dependence for this function (Old Friends). The bottom line is that most of the organisms that drive the regulatory arm of the immune system come from our mothers and family and from the natural environment (including animals) and many of these organisms are symbiotic components of a healthy microbiota. Lifestyle changes that are interrupting our exposure to these organisms can now be identified, and many are closely associated with low socioeconomic status (SES) in wealthy countries. These insights will facilitate the development of education, diets and urban planning that can correct the immunoregulatory deficit, while simultaneously reducing other contributory factors such as epithelial damage.

The effect of COVID-19 vaccine literacy on attitudes towards COVID-19 vaccine among university students

OBJECTIVE

University students are a large group of the population who should be vaccinated to prevent the spread of the pandemic. This research aimed to determine the effect of COVID-19 vaccine literacy on the attitudes towards the COVID-19 vaccine among university students.

METHODS

This descriptive and cross-sectional study was conducted with 2384 university students via online survey in September and October 2021. 'Demographic Information Form', 'COVID-19 Vaccine Literacy Scale', and 'Attitudes towards the COVID-19 Vaccine Scale' were used to collect the data. Data were evaluated via descriptive statistics, independent group t-test, ANOVA, Tukey HSD, and Pearson Correlation analysis.

RESULTS

The mean score on the COVID-19 Vaccine Literacy Scale was 27.26 ± 6.49 (moderate). Demographic differences that significantly affected students' vaccine literacy scales included parents' education levels (lower levels of parental education associated with higher communicative/critical vaccine literacy). Health sciences students had more positive attitudes to the COVID vaccine than students of other disciplines. The higher the level of mother's education, the more positive the student's attitude towards the vaccine, and similarly the higher the student's socio-economic background the higher the positive attitude towards the vaccine. Examination of the relationship between the vaccine literacy scale and the attitudes towards the vaccine showed low levels of correlation.

DISCUSSION

Students who had parents of lower education levels may have more responsibilities for explaining vaccination to their parents, thus improving their communicative/critical vaccine literacy.

CONCLUSION

A vaccine literacy scale with separate functional literacy score and critical/communicative score helps to explain some of socio-demographic differences in students' scores, and similarly for attitude towards the COVID-19 vaccine (positive and negative attitude sub-scales).

COVID-19 Vaccination Actual Uptake and Potential Inequalities Due to Socio-Demographic Characteristics: A Population-Based Study in the Umbria Region, Italy

Socio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns.

Quantifying the impact of SARS-CoV-2 temporal vaccination trends and disparities on disease control

SARS-CoV-2 vaccines have been distributed at unprecedented speed. Still, little is known about temporal vaccination trends, their association with socioeconomic inequality, and their consequences for disease control. Using data from 161 countries/territories and 58 states, we examined vaccination rates across high and low socioeconomic status (SES), showing that disparities in coverage exist at national and subnational levels. We also identified two distinct vaccination trends: a rapid initial rollout, quickly reaching a plateau, or sigmoidal and slow to begin. Informed by these patterns, we implemented an SES-stratified mechanistic model, finding profound differences in mortality and incidence across these two vaccination types. Timing of initial rollout affects disease outcomes more substantially than final coverage or degree of SES disparity. Unexpectedly, timing is not associated with wealth inequality or GDP per capita. While socioeconomic disparity should be addressed, accelerating initial rollout for all over focusing on increasing coverage is an accessible intervention that could minimize the burden of disease across socioeconomic groups.

Strategies for Working With Parents With Vaccination Hesitancy

The purpose of this article is to provide an overview of effective strategies for working with parents' vaccination hesitancy or refusal. An overview of historical and current trends in vaccination hesitancy and factors that contribute to and strategies for addressing vaccine hesitancy are discussed. This includes an emphasis on the critical role played by health care providers, as trusted advisors and a primary source of health care information, in encouraging vaccine acceptance. Legal and ethical implications are also considered. Vaccination hesitancy strategies are most effective if they are timely, multifaceted, and collaborative.

The Role of Hyperarousal and Aberrant Salience in the Acceptance of Anti-COVID-19 Vaccination

Background and Objectives: This present study was aimed at exploring hyperarousal and aberrant salience in a sample of the Italian general population to understand their possible role in the acceptance of anti-COVID-19 vaccination. Materials and Methods: Sociodemographic data questions, the "Acceptance of Vaccination" measure, the Hyperarousal Scale (H-Scale), and the Aberrant Salience Inventory (ASI) were sent as an unpaid online survey to the general population (age range 18-80 years) within the Italian territory. Results: The enrolled subjects were divided into two subgroups: "Pro-vax" (n = 806; 87.4%) and "No-vax" (n = 116; 12.6%). Statistical analysis showed significant differences between groups in the "Education Level" (p = 0.001) category, higher in the "Pro-vax" group, and in the ASI "Senses Sharpening" (p = 0.007), "Heightened Emotionality" (p = 0.008), and "Heightened Cognition" (p = 0.002) subscales with the "Total Score" (p = 0.015), all higher in "No-vax" subjects. Furthermore, a linear regression model evidenced that only "Education Level" (β = 0.143; p < 0.0001) and "Senses Sharpening" (β = -0.150; p = 0.006) were, respectively, direct and inverse predictors of "Acceptance of Vaccination". Conclusions: Our results show that several subthreshold conditions, such as somatosensory amplification, anxiety traits, and panic experiences, should be taken into account by authoritative sources involved in health education, communication, and policy to alleviate public concerns about vaccine safety, for the present and also future pandemics, and to provide more inclusive, informed, and accurate public health preventive and treatment programs.

Factors Associated with Vaccine Refusal (Polio and Routine Immunization) in High-Risk Areas of Pakistan: A Matched Case-Control Study

BACKGROUND

Pakistan has subpar childhood immunization rates and immunization activities have faced several challenges over the past years. We evaluated the social-behavioral and cultural barriers and risk factors for refusal of polio, Routine Immunization (RI), or both in high-risk areas of poliovirus circulation.

METHODS

A matched case-control study was conducted from April to July 2017 in eight super high-risk Union Councils of five towns in Karachi, Pakistan. A total of 3 groups, each with 250 cases, including refusals for the Oral Polio Vaccine (OPV) in campaigns (national immunization days and supplementary immunization activities), RI, and both, were matched with 500 controls and identified using surveillance records. Sociodemographic characteristics, household information, and immunization history were assessed. Study outcomes included social-behavioral and cultural barriers and reasons for vaccine refusal. Data were analyzed in STATA using conditional logistic regression.

RESULTS

RI refusal was associated with illiteracy and fear of the vaccine's adverse effects, while OPV refusals were linked to the mother's decision authority and the assumption that the OPV caused infertility. Conversely, higher socioeconomic status (SES) and knowledge of and willingness to vaccinate with Inactivated Polio Vaccine (IPV) were inversely associated with RI; and lower SES, walking to the vaccination point, knowledge of IPV, and an understanding of contracting polio were inversely associated with OPV refusals, with the latter two also inversely associated with complete vaccine refusal.

CONCLUSION

Education, knowledge and understanding of vaccines, and socioeconomic determinants influenced OPV and RI refusals among children. Effective interventions are needed to address knowledge gaps and misconceptions among parents.

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.

Socioeconomic and demographic characteristics influencing the hesitancy and refusal of COVID-19 vaccine in Ghana

Background

Ghana was the first country to receive the coronavirus vaccination in West Africa from AstraZeneca or Oxford. Ghana plans to vaccinate 20 million out of the 32 million population and provide the necessary doses utilizing multilateral and bilateral agreements. As Ghana begins vaccinating its citizens, there is some skepticism about administering the coronavirus vaccine (CVV). This research aimed to analyze the socioeconomic and demographic characteristics influencing vaccine hesitancy (VH) and refusal among Ghanaians.

Methods

The multinomial logistics regression model was employed to investigate the relationship between respondents' socio-demographic characteristics and VH. The research data were gathered between March to June 2021 through an online survey.

Findings

The findings of this study indicated that approximately 92.75% of the 400 respondents have heard about CVV. The study suggests that less than 5% of the participants have so far received the CVV. Most of the respondents (36.8%) indicated rejecting the CVV. Interestingly, male participants [adjusted odds ratio (AOR) = 1.048; 95% confidence interval (CI): 0.532-2.063] with higher educational backgrounds (AOR = 2.11; 95% CI: 0.870-5.121) had higher odds of being CVV hesitant or refusers. Low economic class, rural settlers, unmarried individuals, and unemployed people also had higher odds of being VH or refusers. The survey also shows that most Ghanaians refused to receive the CVV because they did not trust the system to track the vaccine's side or adverse effects.

Conclusion

Government can use social media platforms and other media platforms to effectively provide relevant information regarding the full benefit and risks of taking the virus.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead

The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Attitude of Parents of Children with Cerebral Palsy Towards COVID-19 Vaccination

Children with cerebral palsy (CP) are at a greater risk of respiratory complications from coronavirus disease 2019 (COVID-19). Therefore, this study aimed to assess COVID-19 vaccine hesitancy (VH) among parents of CP children in Egypt, using the Arabic version of the Parental Attitude about Childhood Vaccination (PACV) questionnaire. This cross-sectional survey study was conducted at the outpatient clinics of two hospitals in Cairo, Egypt. Parents of children with CP were recruited using a simple random sampling technique. A total of 321 parents were enrolled; more than half of them were mothers of the children (61.37%); and the majority were Egyptians (87.23%) and living in urban areas (84.42%). Nearly 70% of the parents were hesitant to administer the COVID-19 vaccine to their children. A multiple linear regression model revealed that the PACV mean scores were lower among the following categories: (1) parents who could pay back loans, compared to those who could not pay back loans and who reported insufficient income (β = -2.39, p = 0.030); (2) non-Egyptian parents (β = -1.54, p = 0.002); (3) those who were fully vaccinated against COVID-19 themselves or had the intention to receive the complete COVID-19 vaccination (β = -6.28, p < 0.001); (4) those who had the intention to give the COVID-19 vaccination to their children (β = -3.04, p < 0.001); and (5) parents whose children received routine vaccines (β = -2.86, p < 0.045). After adjusting for other covariates, the parental COVID-19 vaccine status (β = -6.28, p < 0.001) and parents who experienced a COVID-19-related death in the family (β = -1.75, p < 0.001) showed significantly lower mean PACV scores. However, higher mean PACV scores were reported among parents who had a COVID-19 infection (β = 2.77, p < 0.001) or who were not sure (β = 2.94, p < 0.001). Our findings suggest the need to increase COVID-19 vaccine acceptance among parents of vulnerable children to reduce the negative consequences of COVID-19.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

BACKGROUND

Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes.

METHODS

A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included.

RESULTS

Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes.

CONCLUSIONS

Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Healthcare Workers' Attitudes toward Influenza Vaccination: A Behaviour and Social Drivers Survey

This study aimed to understand the intention and correlation of receiving and recommending influenza vaccine (IV) among healthcare workers (HCWs) in China during the 2022/2023 season using the behavior and social drivers (BeSD) tools. A self-administered electronic survey collected 17,832 participants on a media platform. We investigated the willingness of IV and used multivariate logistic regression analysis to explore its associated factors. The average scores of the 3Cs’ model were compared by multiple comparisons. We also explored the factors that potentially correlated with recommendation willingness by partial regression. The willingness of IV was 74.89% among HCWs, and 82.58% of the participants were likely to recommend it to others during this season. Thinking and feeling was the strongest domain independently associated with willingness. All domains in BeSD were significantly different between the hesitancy and acceptance groups. Central factors in the 3Cs model were significantly different among groups (p < 0.01). HCWs’ willingness to IV recommendation was influenced by their ability to answer related questions (r  =  0.187, p  <  0.001) after controlling for their IV willingness and perceived risk. HCWs’ attitudes towards IV affect their vaccination and recommendation. The BeSD framework revealed the drivers during the decision-making process. Further study should classify the causes in detail to refine HCWs’ education.

The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations

The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC populations. A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality. Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC group were 0.84 (95% CI 0.82-0.87) and 0.67 (95% CI 0.46-0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC population than in the HDC population (HRs for infection: 1.37 95% CI 1.22-1.53 vs. 1.20 95% CI 1.14-1.25; HRs for mortality: 3.96 95% CI 1.82-8.60 vs. 1.71 95% CI 1.50-1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95% CI 4.48-79.87 vs. 3.91 95% CI 2.69-5.69) were larger in HMPC than in the HDC population, but differences could be due to chance. Among the population with diabetes, the HMPC group showed similar incidence (IRR: 0.99 95% CI: 0.88-1.12) and mortality (MRR: 0.89 95% CI: 0.49-1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC populations (HRs: 1.73 95% CI 1.41-2.11 among HDC vs. 1.41 95% CI 0.63-3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on COVID-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.

Antivax attitude in the general population along the autism-schizophrenia continuum and the impact of socio-demographic factors

Introduction

One of the most important inventions in human history is vaccines. However, to date a consistent amount of people exhibit a hesitant approach toward them and mixed results have emerged in the attempt to characterize which factors may play a role in predicting such negative attitude. Here, we aimed at investigating how the individual scoring along the autism-schizophrenic continuum component and socio-cultural factors contribute toward vaccination attitudes in the general population.

Methods

To test whether individual position along the autism-schizophrenic continuum could predict vaccine attitude, we used principal component analysis (PCA) to extract the component showing diametric loading between the Schizotypal Personality Questionnaire (SPQ) and Autistic Quotient (AQ) subscales. Then, we performed a series of multiple linear regression analyses to understand the relation between the ASD-SSD continuum component and Vax scores. We also included socio-demographic factors (i.e., gender, education level, and age) as predictors.

Results

Multiple regression analysis revealed that the closer the individual lied on the positive schizotypal pole, the higher was their negative attitude toward vaccines. A diametric, more favorable disposition was found for individuals closer to the autistic end of the continuum. Furthermore, we reported that among the socio-cultural factors, only age can be considered a significant predictor of vaccination attitudes, with younger participants showing a more positive attitudes toward vaccination, while the level of education is an important protective factor in mitigating the negative impact that the proximity to the SSD pole and age play against vaccination disposition.

Discussion

These findings are relevant to improve targeted public health interventions, highlighting the crucial role of demographic, psychological, and social correlates in predicting anti-vax beliefs, which have the devasting potential to increase the spread of infectious disease.

Exploring vaccine hesitancy: the twofold role of critical thinking

With the progress of the vaccination campaign against the SARS-COV-2, we are ever closer to reaching that part of the population that refuses or is hesitant about vaccination. This study investigated the association between critical thinking motivation factors (i.e., intrinsic value of critical thinking and expectancy of one's critical thinking ability), conspiracy mentality, intolerance of uncertainty and hesitancy toward vaccination. A sample of 390 participants completed an online survey during April 2021. Across participants, results indicate that conspiracy mentality and expectancy about personal ability as a critical thinker positively predict vaccine hesitancy. On the contrary, the intrinsic value attributed to critical thinking, intolerance of uncertainty, and education are negatively associated with hesitancy. While the findings confirm existing evidence, particularly on the detrimental role of conspiracy mentality on vaccine acceptance, they also shed light on the double-faced role exercised by critical thinking. Practical implications and future directions are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04165-w.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Hesitancy for Adult Vaccines Among Healthcare Providers and their Family Members in Delhi, India: A Cross-Sectional Study

Objectives

Adult immunisation has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out to assess hesitancy and the factors influencing the uptake of vaccines in adults.

Methods

A descriptive cross-sectional study was conducted among the medical students and doctors affiliated to a medical college and tertiary care hospital in Delhi, India and their immediate family members in January 2021. Online data collection was done using the Google Form platforms. Data on awareness and perceptions regarding adult vaccination and immunisation status of participants was collected. The dataset was exported in the Microsoft Excel format and analysed with IBM SPSS Version 25 (Armonk, NY: IBM Corp).

Results

A total of 461 adults responded to the survey. The most common reasons for vaccine hesitancy were fear of side effects (51.41%), lack of awareness of vaccines (49.46%), and the lack of national guidelines on adult vaccination (32.97%). Hesitancy for vaccines among those who were informed by healthcare workers of vaccine availability was highest for zoster vaccine (97.80%) and least for tetanus toxoid (57.62%). Significant hesitancy was also observed for pneumococcal, human papillomavirus, influenza and varicella vaccines.

Conclusions

Reduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Framing national guidelines for adult vaccination in India and awareness generation to create a public demand for adult vaccination warrants prioritization.

Knowledge, attitudes, and behaviors toward COVID-19 vaccination in a sample of Italian healthcare workers

Vaccine hesitancy in healthcare workers (HCWs) has been studied for various contagious diseases, but there is still insufficient knowledge about this phenomenon for COVID-19. We developed and validated a knowledge, attitude, and practice survey of 39 questions to assess Italian HCWs' hesitancy toward vaccination in general (general hesitancy), COVID-19 vaccination (COVID-19 hesitancy), and public health injunctive measures (refusal of obligations). The survey was administered through a web platform between July and November 2021. Three multivariable logistic regressions were performed to evaluate the association between the explored dimensions of hesitancy and the potential determinants investigated. Out of 2,132 respondents with complete answers, 17.0% showed to be generally hesitancy toward vaccination, 32.3% were hesitant on COVID-19 vaccination, while 18.8% were categorized as refusing obligations. A significant protective effect against all three dimensions of hesitancy was found for increasing fear of COVID-19, advising COVID-19 vaccination to relatives and patients, having received flu vaccination in the previous year and having higher levels of education. Better self-rated knowledge about COVID-19 vaccines and reading up institutional sources were significantly protective against general and COVID-19 hesitancy, while being a physician rather than another healthcare professional was protective only against COVID-19 hesitancy. Conversely, increasing age and referring to colleagues to expand knowledge about COVID-19 were positively associated with COVID-19 hesitancy. The determinants of general hesitancy, COVID-19 hesitancy and the refusal of obligations are mostly overlapping. Given the great influence they exert on patients and communities, it is pivotal to limit HCWs vaccine hesitancy through appropriate training activities.

How to counter the anti-vaccine rhetoric: Filling information voids and building resilience

Widely circulating anti-vaccine misinformation online has been constituting a large obstacle for the success of COVID-19 vaccination campaigns and for the well-being of people during the pandemic. In this paper we discuss strategies to mitigate negative effects of online anti-vaccine contents on public health and to prevent hesitant individuals from falling prey of the traps set by anti-vaccine disinformation spreaders. Here we discuss the importance of filling information voids and understanding trends and concerns that shape the vaccine debate, and we highlight the relevance of building resilience to vaccine misinformation by strengthening public health and digital literacy.

Factors influencing parents' willingness to vaccinate their preschool children against COVID-19: Results from the mixed-method study in China

During the COVID-19 pandemic, little is known about parental hesitancy to receive the COVID-19 vaccine for preschool children who are the potential vaccinated population in the future. The purpose of this mixed-method study was to explore the factors influencing Chinese parents' decision to vaccinate their children aged 3-6 years old against COVID-19. In July 2021, we conducted semi-structured interviews (n = 19) and a cross-sectional survey (n = 2605) with parents of kindergarten children in an urban-rural combination pilot area in China. According to the qualitative study, most parents were hesitant to vaccinate their children with the COVID-19 vaccine. In the quantitative study, we found that three-fifths of 2605 participants were unwilling to vaccinate their children against COVID-19. Furthermore, the main predictors of parents' intention to vaccinate their children were fathers, lower level of education, and positive attitudes toward vaccination. Based on our findings, targeted health education techniques may be able to boost childhood COVID-19 immunization rates.

Hesitant and anti-vaccination groups: A qualitative study on their perceptions and attitudes regarding vaccinations and their reluctance to participate in academic research- an example during a measles outbreak among a group of Jewish parents in Israel

Background

Vaccination is widespread in Western countries and, overall, there is a high vaccination rate. However, immunization is still an enduring challenge. In recent years, the number of parents who choose to delay or refuse vaccines has risen.

Objectives

(1) to identify the perceptions and attitudes of hesitant and anti-vaccination parents regarding vaccination in general, and vaccinating their children in particular and; (2) to describe the responses of potential participants to the request to participate in academic research regarding their perceptions and attitudes on the subject of vaccines.

Methods

The research employs the qualitative hermeneutic phenomenological method using two research tools: (1) in-depth interviews with 7 hesitant and 11 anti-vaccination Jewish parents in Israel; and (2) the researchers' field notes from this study process, which describe the responses of 32 potential participants to the request to participate in this academic research.

Results

The main findings indicate that while most of the interviewees admit to the efficacy of vaccines in preventing diseases, they oppose the way in which vaccines are promoted-based on providing partial information and disregarding parents' concerns and questions. Therefore, they demand transparency about the efficacy and safety of vaccines. The findings also point to a paradoxical finding. On the one hand, these groups claim that health organizations do not understand their position, referring to them as "science-deniers", even though they are not. On the other hand, these parents choose to refrain from participating in scientific studies and voicing their opinions, thereby perpetuating the situation of being misunderstood.

Conclusion

Hesitant and anti-vaccination groups express mistrust in academic institutions and health organizations. Therefore, an effective dialogue that would include hesitant and anti-vaccination groups, the academy, and health organizations may contribute to a better understanding of the barriers that prevent these groups from getting vaccinated or vaccinating their children and promote public health.

[The determinants of SARS-CoV-2 vaccine hesitancy in a rural area of an Indonesia-Philippines border island: A mixed-method study]

Background

The SARS-CoV-2 vaccination program campaign has been underway in Indonesia for people aged ≥ 18 years. The program's success can be hampered by vaccine hesitancy in communities. This study aims to elucidate the determinants of SARS-CoV-2 vaccine hesitancy in a rural area of the Indonesia-Philippines border island Sangihe.

Methods

A mixed-methods study was conducted; a quantitative part involving a cross-sectional survey was carried out among participantes aged ≥ 18 years to determine the prevalence and determinants of SARS-CoV-2 vaccine hesitancy. The qualitative part involved in-depth interviews to explore the perceptions towards the SARS-CoV-2 vaccine.

Result

Among 557 participantes, the prevalence of vaccine hesitancy was 63.9% (95% CI: 59.8-67.9). In the adjusted analysis, three factors affected vaccine hesitancy: education (aOR: 0.40; 95% CI: 0.22-0.70), knowledge of the SARS-CoV-2 vaccine (aOR: 2.17; 95% CI: 1.41-3.34) and willingness to pay (aOR: 0.12; 95% CI: 0.07-0.20). The majority of reasons for refusing the vaccine included doubt regarding its safety and effectiveness, the fear of side effects, lack of information regarding the vaccine and local Christians' religious beliefs.

Conclusion

This study found that most adults in the area were hesitant about the SARS-CoV-2 vaccine. Lack of knowledge, a low level of education and misinformation were factors that greatly affected vaccination hesitancy. The government, by involving religious leaders, is expected to pay serious attention to the dissemination of accurate and convincing information to the public regarding the safety and importance of the SARS-CoV-2 vaccine.

The Development and Preliminary Application of the Chinese Version of the COVID-19 Vaccine Literacy Scale

(1) Background: Vaccine literacy (VL) of the public is crucial to deal with anti-vaccination rhetoric. This study aims to (1) develop a Chinese COVID-19 Vaccine Literacy Scale and examine the factor structure and psychometric characteristics, and (2) explore the association between COVID-19 VL and sociodemographic characteristics and other variables; (2) Methods: An online cross-sectional survey was conducted among 362 Chinese residents from 23 May 2022 to 31 May 2022 using snowball sampling; (3) Results: Exploratory and confirmatory factor analysis indicated that the scale of 15 items, consisting of three factors, functional, interactive and critical vaccine literacy, explained 63.3% of the total variance. Cronbach's α coefficient was 0.885 for the overall scale: 0.838, 0.891, and 0.857 for three subscales, respectively. The results showed a medium level of vaccine literacy (M = 3.71, SD = 0.72) and significant differences among functional, interactive, and critical vaccine literacy (p < 0.001). The level of vaccine literacy grew with the level of education (p < 0.001) and age (p = 0.049). Men, participants who were single, or those living in rural areas had a lower level of vaccine literacy; (4) Conclusions: The Chinese COVID-19 VL Scale has adequate validity and reliability for assessing vaccine literacy among Chinese residents. A deep understanding of the factors that affect vaccine literacy is needed.

The effect of vaccination beliefs regarding vaccination benefits and COVID-19 fear on the number of vaccination injections

The Coronavirus disease pandemic of 2019 is a vast worldwide public health hazard, impacting people of all ages and socioeconomic statuses. Vaccination is one of the most effective methods of controlling a pandemic like COVID-19. This study aims to investigate the relationship between the number of vaccination injections and fear of COVID-19 and test whether beliefs benefit from vaccination COVID-19 mediate the effect of fear of COVID-19 on the number of vaccination injections. A total of 649 Vietnamese adults were enrolled online to finish answering, including scales The Health Belief Model (HBM) and The Fear of COVID-19 (FCV-19S), consisting of 340 (52.4%) males and 309 (47.6%) females. The data were analyzed using variance, regression, and a simple mediation model. The total score of COVID-19 fear was M = 22.26, SD = 5.49. Vietnamese fear of COVID-19 was at a medium level. Our results suggest that 18- to 20-year-olds are more fearful of COVID-19 than others. People who received the first dosage exhibited a greater fear of COVID-19 than those who received the second dose and were not inoculated. Additionally, the beliefs benefit of vaccination COVID-19 has a role in the relationship between the number of vaccination injections and fear of COVID-19. During the pandemic, adults in Vietnam are more afraid of COVID-19 than during prior outbreaks. Besides, the Vietnamese populace demonstrated a considerable demand for and high acceptability of the COVID-19 vaccine. The current study indicates that psychological counselors and therapists should counsel clients on the value of vaccination and address the fear of COVID-19 as public understanding of the benefits of vaccines increases. To further clarify the effect of this issue on the correlation between fear of COVID-19 and the number of vaccinations, the results of this study indicate that the existing vaccine communication factor for COVID-19 vaccination should be modified to increase confidence in the benefits of immunization.