The Strategies to Support the COVID-19 Vaccination with Evidence-Based Communication and Tackling Misinformation

Watchful, skeptics, and system distrusters: Characteristics associated with different types of COVID-19 vaccine hesitancy among U.S. working-age adults

COVID-19 vaccine hesitancy is complex, with adults identifying various reasons for not getting vaccinated. Using data from the 2022 National Wellbeing Survey on 7612 U.S. adults aged 18-64, we identified how age, race/ethnicity, sex, marital status, education, income, employment status, partisanship, and metropolitan status are associated with COVID-19 vaccination status and three non-mutually exclusive types of vaccine hesitancy: 1) watchful, concerned about vaccine side effects and efficacy; 2) skeptics, distrust the vaccine, and 3) system distrusters, distrust government. A third of respondents overall (N = 2643) had not received at least one dose at the time of the survey. Among respondents who were not vaccinated, 67 % are classified as watchful, 53 % are skeptics, and 32 % are system distrusters. Results from logistic regression show that concerns about side effects and safety (watchfulness) appear to be major drivers for not getting vaccinated among females and among non-Hispanic Black and unmarried adults, whereas skepticism and distrust appear to be more important barriers among ages 25-44. All three types of hesitancy appear to be important contributors to lower vaccination uptake among low-income, low-education, and unemployed adults, and among individuals who voted for Donald Trump in the 2020 election (with skepticism and distrust being most endorsed by this group). Findings suggest that universal messaging and intervention strategies are unlikely to be effective in reducing vaccine hesitancy. Different messages, messengers, and tactics must be used with different groups.

Covid-19 vaccine uptake and its associated factors among adult population in Dangila district, Awi Zone, Northwest Ethiopia: A mixed method study

INTRODUCTION

Vaccination is the most cost-effective approach that significantly reduces morbidity and mortality related to Coronavirus disease -19 (COVID-19). Nevertheless, there is a lack of information on the COVID-19 vaccine uptake and related factors in Ethiopia including the research area.

OBJECTIVE

To assess COVID-19 vaccine uptake and its associated factors among adult population in Dangila District, Awi Zone, Northwest Ethiopia, 2023.

METHODS

A community-based mixed-type study design was conducted from Oct, 15-Nov 15/2022. The study population was chosen using the multistage stratified random sampling technique for the quantitative study and the purposive sampling method for the qualitative inquiry. The collected data were managed and analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were employed to identify factors associated with vaccine uptakes. In the qualitative part of the study, key informant interview was applied. After the interview was listened, the transcripts were coded and categorized into themes, and analyzed using Atlas.ti 7 software. Finally, the finding was triangulated with the quantitative results.

RESULT

The vaccine uptake among the adult population was found to be 47% (95% CL: 42.7%, 51.0%). History of having test for COVID-19 (AOR: 1.70, 95% CI: 1.02, 2.84), good knowledge about COVID-19 vaccine (AOR; 3.12, 95% CI; 2.11, 4.59), no formal education (AOR: 1.78, 95%: 1.26, 2.58), good attitude (AOR: 3.21, 95% CI: 2.13, 4.89), being in poor Income category (AOR: 1.83, 95% CI: 1.08, 3.06), being female (AOR: 1.75, 95% CI: 1.2, 2.58) and living in rural area (AOR: 3.1, 95% CI: 1.87, 5.12) were significantly associated with vaccine uptake rate. The study also identified that misperceptions about the vaccine efficacy and safety, availability of vaccine, lack of knowledge about the vaccine, mistrust of the corona virus vaccine, fear of adverse effects, social media influence and religious beliefs were found to be barriers of COVID -19 vaccine uptake.

CONCLUSION

In the Dangila district, adult population vaccination uptake for COVID-19 was comparatively low. To raise the rate of vaccination uptake, interventions must focus on the identified modifiable factors.

Public Perception Toward the Malaysian National COVID-19 Immunisation Programme (PICK) in the State of Sabah, Malaysia: A Cross-Sectional Survey

The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann-Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community's perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.

Examination of Nursing Staffs' Perceptions of the COVID-19 Vaccine Using the Health Belief Model

BACKGROUND

The coronavirus (COVID-19) pandemic profoundly impacted patient care across the United States.

OBJECTIVE

To examine nursing staffs' perceptions of the COVID-19 vaccine using the Health Belief Model (HBM) as a theoretical framework.

METHODS

A cross-sectional, anonymous, web-based survey was completed by practicing nursing staffs throughout the United States. Analyses involved descriptive and comparative statistics.

RESULTS

Of the 294 nursing staff who completed surveys, 50% were between 18 and 37 years of age, and 73.1% were registered nurses, with 49.3% employed in a hospital setting. Nursing staff reported their primary reason for vaccination was concern for others (mean: 84.44; SD: 28.26), vaccine prevents spread (mean: 81.85; SD: 28.94), and own health (mean: 79.63; SD: 30.0). Influencing factors that predicted vaccination included age, Wilks' Λ = 0.76, F(32, 919.86) = 2.20, p < .001, η2partial = 0.066, and the vaccine mandate, Wilks' Λ = 0.63, F(8, 249) = 18.61, p < .001, η2partial = 0.374.

CONCLUSION

Nursing staffs' perceptions using the HBM as a theoretical framework provided insight into their decisions to receive the COVID-19 vaccine. Further research is warranted to examine nurses' attitudes and factors that influence their decision-making regarding vaccination.

Low uptake of COVID-19 vaccines in Wad Medani City, Gezira State, Sudan: Hesitancy and poor accessibility

Vaccination is an important strategy in the fight against COVID-19. Although Sudan received vaccines since March 2021, vaccine uptake is very low. This study aimed to determine COVID-19 vaccine uptake and hesitancy in one of the largest Urban settings in Sudan. A survey was done among adults from 15 market places in Wad Medani city. Collected data included; demographic characteristics, vaccination status, type of received vaccine, number of received doses, side effects experienced after vaccination and reasons for refusing or delaying vaccination. In total, 1323 questionnaires were eligible for analysis. Most respondents were male (55.5%), younger than 60 years of age (89.5%) and received some sort of formal education (92.7%). Education level was significantly associated with vaccination uptake (p < 0.001). At the time of the study; 33.2%, 42%, 16.8% and 8% of participants were vaccinated, willing to receive vaccination, rejecting vaccination or haven't decided to receive a COVID-19 vaccine yet respectively. The most common reason for rejection indicated by participants was safety concerns (79.3%). Reasons for hesitance expressed by 64% of participant who said they were willing to take the vaccine were unavailability and difficult access to vaccines. Participants who expressed willingness to receive COVID-19 vaccine (42%) or were undecided (8%) were invited to a vaccination campaign. Of these, 27.9% attended and received their first shot of COVID-19 vaccine. Education level seems to be the main determinant for vaccination hesitancy. Safety concerns seem to play a major role in rejecting and delaying COVID-19 vaccination. Assuring vaccine's safety seems to be the way forward to reduce concerns about vaccination safety. Hesitancy was also shown to be partially related to difficulty in access to vaccines and a large proportion of the population are expected to receive the vaccine by improving availability and access.

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Unraveling the association between vaccine attitude, vaccine conspiracies and self-reported side effects following COVID-19 vaccination among nurses and physicians in Jordan

Background

The negative impact of vaccine conspiracies is linked with negative health behavior. The aim of the current study was to examine the association between attitudes toward booster COVID-19, influenza, and monkeypox (mpox) vaccinations with post-COVID-19 vaccine side effects, vaccine conspiracies, and attitude towards mandatory vaccination among nurses and physicians in Jordan.

Methods

A structured closed-ended questionnaire was used to collect data on demographics, COVID-19 history, COVID-19 vaccine type and doses received, self-reported side effects post-COVID-19 vaccination, acceptance of booster COVID-19, seasonal influenza, and mpox vaccinations, attitudes towards mandatory vaccination, and beliefs in vaccine conspiracies.

Results

The study sample comprised a total of 341 participants. Acceptance of yearly booster COVID-19 vaccination was expressed by 46.6% of the sample, while 73.3% accepted seasonal influenza vaccination, and only 37.0% accepted mpox vaccination. A higher frequency of self-reported side effects following the first COVID-19 vaccine dose was associated with embrace of vaccine conspiracies and vaccine type. For the second vaccine dose, a higher frequency of self-reported side effects was associated with the embrace of vaccine conspiracies, older age, and affiliation to private sector. In multinomial logistic regression analyses, the lower embrace of vaccine conspiracies was associated with lower odds of reporting side effects post-COVID-19 vaccination. The lower embrace of vaccine conspiracies and favorable attitude towards mandatory vaccination were associated with the willingness to get COVID-19, influenza, and mpox vaccinations.

Conclusion

The study findings highlighted the negative impact of embracing vaccine conspiracies on health-seeking behavior among nurses and physicians. The findings indicated that the willingness to get vaccinated was associated with lower endorsement of vaccine conspiracies. Additionally, the lower embrace of vaccine conspiracies was associated with a lower frequency of self-reported side effects following COVID-19 vaccination. These results emphasize the importance of addressing vaccine misinformation and promoting accurate information to ensure optimal vaccine uptake and public health outcomes.

The Heat about Cultured Meat in Poland: A Cross-Sectional Acceptance Study

Cultured meat, produced by culturing animal cells in vitro, is gaining increasing interest. The first products obtained using this technology were authorized for human consumption in Singapore and the United States, and more are likely to follow in other parts of the world. Therefore, it is important to assess the attitudes toward such meat in various populations and understand the grounds for its acceptance and rejection. The present cross-sectional online study of adult Poles (n = 1553) aimed to evaluate knowledge of cultured meat, the main reasons and fears associated with its production and consumption, and willingness to buy it and factors influencing such willingness. Most respondents (63%) were familiar with the concept of cultured meat, and 54% declared to purchase it when available. However, concerns over safety were expressed by individuals accepting (39%) and rejecting (49%) such meat. The main motivations for choosing it included limiting animal suffering (76%) and environmental impacts of meat consumption (67%), although over half of responders willing to buy these products were driven by curiosity (58%). Multiple logistic regression revealed that odds (OR; 95%CI) for accepting cultured meat were significantly increased for adults aged 18-40 (1.8; 1.2-2.7); women (1.8; 1.2-2.7); meat eaters (8.7; 5.6-13.6); individuals convinced that animal farming adversely affects the climate (7.6; 3.1-18.3), surface waters (3.1; 1.2-8.1), and air quality (3.0; 1.2-7.6); those familiar with cultured meat concept (4.2, 2.2-8.4); and those revealing high openness to experience (1.7; 1.2-2.4). The results highlight that the Polish population may be moderately ready to accept cultured meat and identify the groups resistant to accepting it. Well-designed and transparent promotion of these products is required to increase the general public's understanding of the potential benefits and challenges of cultured meat technology.

Key Considerations during the Transition from the Acute Phase of the COVID-19 Pandemic: A Narrative Review

The COVID-19 pandemic has been met with an unprecedented response from the scientific community, leading to the development, investigation, and authorization of vaccines and antivirals, ultimately reducing the impact of SARS-CoV-2 on global public health. However, SARS-CoV-2 is far from being eradicated, continues to evolve, and causes substantial health and economic burdens. In this narrative review, we posit essential points on SARS-CoV-2 and its responsible management during the transition from the acute phase of the COVID-19 pandemic. As discussed, despite Omicron (sub)variant(s) causing clinically milder infections, SARS-CoV-2 is far from being a negligible pathogen. It requires continued genomic surveillance, particularly if one considers that its future (sub)lineages do not necessarily have to be milder. Antivirals and vaccines remain the essential elements in COVID-19 management. However, the former could benefit from further development and improvements in dosing, while the seasonal administration of the latter requires simplification to increase interest and tackle vaccine hesitancy. It is also essential to ensure the accessibility of COVID-19 pharmaceuticals and vaccines in low-income countries and improve the understanding of their use in the context of the long-term goals of SARS-CoV-2 management. Regardless of location, the primary role of COVID-19 awareness and education must be played by healthcare workers, who directly communicate with patients and serve as role models for healthy behaviors.

Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study

BACKGROUND

Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide.

OBJECTIVE

The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance.

METHODS

This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term "" (vaccine), selected "" (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame.

RESULTS

The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, "political role" was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords "side effects," "vaccine associated deaths," and "vaccine protection" continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as "side effects" prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and "side effects" and "vaccine protection" during the period when multiple vaccines were available.

CONCLUSIONS

Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication.

Family Medicine and Primary Healthcare: The Past, Present and Future

As defined by the World Health Organisation in the conference held in Alma Ata, Kazakhstan, in 1978, "Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination" [...].

Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review

BACKGROUND

Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region.

METHODS

This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers.

RESULTS

A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns.

CONCLUSIONS

This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy.

REGISTRATION AND FUNDING

Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.

The Influence of Recommendation of Medical and Non-Medical Authorities on the Decision to Vaccinate against Influenza from a Social Vaccinology Perspective: Cross-Sectional, Representative Study of Polish Society

Vaccination against seasonal flu is crucial to prevention of illness in modern societies. The level of influenza vaccination in Poland is low and, for many years, has hovered around a few percent of the general population. For this reason, it is crucial to understand the reasons for such a low level of vaccination and to assess the influence of medical and social authorities on the decision to vaccinate against influenza from the perspective of social vaccinology. For this purpose, a representative survey was conducted in 2022 among adult Poles (N = 805), orchestrated with the CAWI technique based on the author's questionnaire. The most significant authority in the context of influenza vaccination is held by physicians, especially among the oldest part of the population, over 65 years of age-in this group, 50.4% of respondents declare a very high level of respect for physicians on the issue of recommended influenza vaccination (p < 0.001), and the second-highest authority group for which seniors have respect in the aspect of influenza vaccination is pharmacists (p = 0.011). It was also shown that pharmacists have more authority on the issue of influenza vaccination than nurses, especially in the group that declared themselves opponents of vaccination (p < 0.001). The survey indicates the need to strengthen the authority of physicians and pharmacists regarding influenza vaccination, and, in the case of pharmacists, the need for changing the law to allow them to qualify for influenza vaccination.

Willingness to COVID-19 vaccination: Empirical evidence from EU

The unforgettable COVID-19 shock is most likely to be reversed by a viable vaccination strategy. In this paper, we investigate willingness to be vaccinated (WTV) against the COVID-19. Current trends suggest that only around 73% of EU inhabitants (15 and +) were immunized, with more than 104 million people still warranted to be immunized. Vaccine reluctance is a key impediment to conducting immunization programs in the setting of a pandemic. We provide first of its kind empirical evidence on the citizens (N = 11,932) of the EU-27 by employing the recent data from the European Commission. Based on the survey responses, controlling for the correlations in the error terms, we utilize a simulated multivariate probit regression model. Our results show that amongst all the statistically significant drivers of the WTV, the positive perception (vaccination works and has no side effects); R&D information (clarity on how vaccination is developed, tested, authorized) has the largest impact on the WTV. We find that the group of variables on social feedback (Positive perception; social adoption and pressure), and on trustworthy sources of information (R&D info; medical advice) are to be considered for WTV policy. The counteracting policy gaps that act against WTV include vaccination governance dissatisfaction, perception of long-term side effects, growing mistrust in information sources, uncertainty between safety and efficacy, education level, and risky age group. Strategies based on the outcomes of this study are needed to address public acceptance and willingness to vaccinate during a pandemic. This research is novel and offers authorities in-depth insights into the challenges and solutions regarding the COVID-19 pandemic and thus to its end via stimulation of the WTV.

First Year of Special Issue "New Insights in Vaccination and Public Health": Opinions and Considerations

Disease prevention and control is the foundation of public health [...].

Knowledge, Attitudes, and Perception as Predictors of COVID-19 Safety Practices of Ride-Hailing Operators in Ghana: A Cross-Sectional Study

Since its outbreak, health authorities have launched vigorous COVID-19 health promotion campaigns. This study assesses ride-hailing operators' COVID-19 knowledge, attitudes, and practices in Ghana, with the aim of engendering precautionary behaviour among the populace. A complementary mixed methods approach was adopted. This involved a cross-sectional survey of 1014 participants who were also allowed to share their COVID-19-related lived experiences qualitatively after successfully completing the survey. The aggregate correct knowledge score was 84%. Most respondents were frightful of the virus (96%), but the majority had faith in the COVID-19 protocols (87%). Thus, most participants reported high use of face masks (95%) and practise personal hygiene (92%). However, social media misinformation and the subsequent complacency have dissuaded some participants from complying with the safety protocols. The qualitative data also show evidence of high susceptibility to COVID-19. The perceived benefits of safe behaviour, including masking up, were equally high among drivers surveyed, albeit barriers to preventative behaviours remain rife. Therefore, this study emphasises the importance of sustaining and improving public awareness by highlighting the susceptibility of all demographic groups to the virus and the need to counteract misinformation on social media.

Association between the Seroprevalence of Antibodies against Seasonal Alphacoronaviruses and SARS-CoV-2 Humoral Immune Response, COVID-19 Severity, and Influenza Vaccination

The present study assesses the seroprevalence of antibodies against seasonal human alphacoronaviruses 229E and NL63 among adult patients infected with SARS-CoV-2, and its association with the humoral response to SARS-CoV-2 infection and its severity, and influenza vaccination. A serosurvey was conducted to quantify the presence of IgG antibodies against the nucleocapsid of 229E (anti-229E-N) and NL63 (anti-NL63-N), and anti-SARS-CoV-2 IgG antibodies (against nucleocapsid, receptor-binding domain, S2 domain, envelope, and papain-like protease) for 1313 Polish patients. The seroprevalence of anti-229E-N and anti-NL63 in the studied cohort was 3.3% and 2.4%. Seropositive individuals had a higher prevalence of anti-SARS-CoV-2 IgG antibodies, higher titers of the selected anti-SARS-CoV2 antibodies, and higher odds of an asymptomatic SARS-CoV-2 infection (OR = 2.5 for 229E and OR = 2.7 for NL63). Lastly, the individuals vaccinated against influenza in the 2019/2020 epidemic season had lower odds of seropositivity to 229E (OR = 0.38). The 229E and NL63 seroprevalence was below the expected pre-pandemic levels (up to 10%), likely due to social distancing, increased hygiene, and face masking. The study also suggests that exposure to seasonal alphacoronaviruses may improve humoral responses to SARS-CoV-2 while decreasing the clinical significance of its infection. It also adds to accumulating evidence of the favorable indirect effects of influenza vaccination. However, the findings of the present study are of a correlative nature and thereby do not necessarily imply causation.

Barriers and Facilitators to COVID-19 Vaccine Uptake among Polish Patients: A Qualitative Interview Study

The decision to receive a COVID-19 vaccine is influenced by a variety of individual and contextual factors. However, there are very few studies that analyse individual vaccination decisions using a qualitative methodology. To close this gap, we conducted a qualitative interview study to examine the opinions and experiences with the vaccine among patients previously hospitalized due to COVID-19, including barriers and facilitators to vaccine uptake. An exploratory qualitative study, using semi-structured telephone interviews, was conducted among 22 patients admitted for COVID-19 in Poland in 2022. Opinions of patients previously hospitalized with COVID-19 on vaccination were varied. Barriers to COVID-19 vaccine uptake stemmed from concerns about vaccine safety, patients' religious beliefs, and negative stories. High disease severity and anxiety over personal and family health were important arguments in favour of receiving the COVID-19 vaccine. The study findings indicated the need for ongoing health education by healthcare staff as well as coordination and integration of multi-sectoral institutional measures regarding COVID-19 prevention strategies as well as increased public health initiatives on social media and engagement of community leaders for awareness about vaccines and vaccination. It is crucial to build trust in COVID-19 vaccinations among the general public by disseminating reliable information through trustworthy and credible sources. However, it ought to be emphasised that, regardless of the measures taken, some individuals will remain unconvinced about receiving a COVID-19 vaccine.

"I won't be a guinea pig": Rethinking public health communication and vaccine hesitancy in the context of COVID-19

At the beginning of 2021, when Canada started distribution of COVID-19 vaccines, the unprecedented scope and severity of the pandemic led to very high levels of public awareness and attention, with Canadians actively seeking information. We argue that while there was continuous public health communication about COVID-19 and the newly available vaccines, these messages did not address the specific anxieties elicited by the novel vaccines, even as vaccination guidelines changed. Instead, public health messages about COVID-19 vaccines resembled those aimed at reducing vaccine hesitancy for routine immunization and did not sufficiently address the constant changes to COVID-19 vaccine recommendations. In a context of heightened public concern and significant public attention, it is crucial for communicators to acknowledge that hesitancy is vaccine-specific, and that novel diseases and new vaccines produce specific concerns. Long-term strategies should address the novelty of the technology and of the risk, thoroughly explain the reasons for shifting vaccination guidelines, and leverage trusted sources, such as community leaders. Further, as COVID-19 vaccines become less effective against some of the more recent variants of the virus, vaccine messaging needs to be tailored to evolve with shifting realities to not lose productive gains in the COVID-19 vaccination campaign to date.

Talking about the Vaccine after the Pandemic: A Cross-Sectional Study among Youth in Turkey and Ethical Issues

Examining the factors that affect the vaccination rate among young people in an ethical frame can support vaccination promotion. Therefore, this study will elaborate, through an ethical lens, on young people's hesitation about and decisions regarding getting vaccinated. The cross-sectional study was conducted with 2428 people aged 15-30 in Turkey in June 2022. The questionnaire included the following subtitles: psycho-social situation, health services and health policies, COVID-19 vaccine, and predictions about life and health after the pandemic. The average age was 22.9 years. In the study sample, 80% were vaccinated, while 20% were not. Vaccinated participants acted more cautiously to protect their health. Receiving accurate and sufficient information on proposed vaccines affects vaccination status. The primary reason for getting vaccinated was "to protect their health, families, and relatives", and the primary reason for not getting vaccinated was "not trusting the vaccine content or the country where the vaccine was produced". Specifically, those vaccinated felt more relaxed physically, psychologically, and socially. In addition, the expectations for the future of those vaccinated were significantly higher. Accurate and adequate information is essential for reducing vaccine hesitancy. In addition, promoting prosocial behaviors in young people and highlighting related values will support vaccination.

When good messages go wrong: Perspectives on COVID-19 vaccines and vaccine communication from generally vaccine accepting individuals in Canada

Vaccines are one of the most important and successful public health interventions to reduce the spread of infectious diseases. However, unlike childhood diseases and routine vaccines, COVID-19 is a novel threat, and COVID-19 vaccines may elicit specific anxieties. Through focus groups, we examine the concerns and attitudes toward the COVID-19 vaccine expressed by individuals who accept routine vaccinations in Canada. We also conducted a pre-focus group survey to document participant attitudes towards vaccines in general. While most participants had received at least one dose of the COVID-19 vaccine or had the intention to get it, many had concerns. First, participants felt anxious about the quick development and approval of the vaccines, even if they recognized that the vaccines have undergone clinical trials. Second, participants felt confused about shifting public health guidelines regarding vaccine safety, changing the interval between doses, and mixing different vaccine brands. Finally, participants said they felt abandoned when deciding whether to get vaccinated or not. People who generally accept vaccines expressed concerns about COVID-19 vaccines, mostly related to the inevitable uncertainties of a new vaccine (i.e. novelty, safety, mandates, etc.). COVID-19 vaccine hesitancy, understood as concerns about the novelty of a vaccine and the rapid implementation of it, could be useful for understanding questioning attitudes towards COVID-19 vaccines from people who accept routine vaccinations. Understanding COVID-19 vaccine hesitancy can also provide valuable insights as booster doses are periodically needed and people may not be as accepting of these additional doses.

Causal Modeling of Descriptive Social Norms from Twitter and the Physical World on Expressed Attitudes Change: A Case Study of COVID-19 Vaccination

The high infection rate of SARS-CoV-2 makes it urgent to promote vaccination among the public. Previous studies found that people tend to follow the behaviors desired in descriptive social norms, which exist in both social media (e.g., Twitter) and physical-world communities. However, it remains unclear whether and to what extent the descriptive social norms from the cyber and physical communities affect people's attitude change. This study, focusing on COVID-19 vaccination, developed a Directed Acyclic Graphs model to investigate the causal effects of the descriptive social norms of (i) Twitterverse and (ii) physical-world communities on people's attitude change as well as the temporal scales of the effects. It used a Long Short-Term Memory classifier to extract expressed attitudes and changes from relevant tweets posted by 843 sample users. We found that a people's attitude change toward the vaccination receives a more significant impact from Twitter-based descriptive social norms over the prior week, whereas the norms in the physical-world communities tend to be less influential but still notable with the time gap between 2 weeks and 1 month. The findings revealed the potential of using online social norm approaches to proactively motivate behavioral changes toward a culture of health.

Factors influencing COVID-19 vaccine acceptance and hesitancy among rural community in Bangladesh: A cross-sectional survey based study

Although more than one hundred million beneficiaries were administered COVID-19 vaccine until 20th February, 2022 in Bangladesh; however, proportionally a low turnout has been recorded in rural places and a substantial gap exist among the people living in rural and urban areas concerning the ratio of receiving vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to identify the potential factors influencing vaccine acceptance and hesitancy among the rural community in Bangladesh. A bilingual, self-administered anonymous questionnaire was developed, and data were collected between 10th June 2021 and 14th August 2021 through face-to-face interview. 655 rural people participated in this cross-sectional study, and sampling was done randomly. Descriptive statistics and binary logistic regressions were used to explore and rationalize study objectives. Out of 655 rural participants, 552 (84.3%, 95% CI 81.2─86.8) responded to accept COVID-19 vaccine; however, minor fractions (n = 5, n% = 0.8, 95% CI 0.12-1.4) of rural community had willingness to pay (WTP) for a COVID-19 vaccine. The result of binary regression showed that "safety," "side effects," "effectiveness," and "trust" had highly significant (p <.01) and positive correlation with vaccine acceptance intention. "Rumor" had moderately significant (p <.05) and negative association while "gender" had insignificant correlation with vaccine acceptance intention. Easy and constant access to evidence-based and trustworthy information on vaccination consequences is imperative for resource-less remote people. Health communication regarding safety, side effect, and effectiveness of vaccines were identified as the most important predictor to convert vaccines to vaccinations and for ensuring mass immunization against COVID-19 in Bangladesh.

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

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics

Background

Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method.

Methodology

Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests.

Results

The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access.

Conclusion

A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.

Religiosity and Beliefs toward COVID-19 Vaccination among Adults in Puerto Rico

Religiosity may influence COVID-19 vaccination. However, it remains unclear how religiosity is associated with beliefs toward COVID-19 and vaccination against it, particularly amongst ethnic minorities. This study examined the association between religiosity, vaccination intent, beliefs, and attitudes related to COVID-19 and vaccination among adults in Puerto Rico. Data from an online survey conducted between December 2020-February 2021 among adults (≥18 yr; n = 1895) residing in Puerto Rico were used. Rating of the importance of religiosity was used to capture the level of religiosity ('less important', 'somewhat important', 'important', and 'very important'). The health belief model (HBM) assessed beliefs and attitudes toward COVID-19 and vaccination against it. Adjusted Poisson models with robust error variance estimated prevalence ratios (PR) and 95% confidence intervals for vaccination intent and individual COVID-19 HBM constructs. Compared to individuals rating religiosity as 'less important' to them, those rating it as 'very important' were more likely to be unwilling or uncertain to get the COVID-19 vaccine (PR = 1.51, 95% CI = 1.10-2.05). Higher ratings of importance of religiosity, compared to the lowest level, were associated with significantly lower perceived COVID-19 susceptibility, more vaccine barriers, and lower vaccine benefits (all p < 0.05). Individuals who reported religiosity being very important to them were more likely to report that they will get the COVID-19 vaccine only if given adequate information about it (PR = 1.14, 95% CI = 1.02-1.27) and more likely to get the vaccine if more people decide to receive it (all p < 0.05). In conclusion, our results suggest an association between religiosity and COVID-19 vaccination intent and beliefs and attitudes toward vaccination. The study highlights important guidelines for public health campaigns to increase vaccine uptake among religious communities in Puerto Rico.

Pseudoscience and fraudulent products for COVID-19 management

As of now, the COVID-19 pandemic has become uncontrolled and is spreading widely throughout the world. Additionally, new variants of the mutated viral variants have been found in some countries that are more dangerous than the original strain. Even vaccines cannot produce complete protective immunity against the newer strains of SARS-CoV-2. Due to such a dreadful situation, lots of fear and depression have been created among the public. People are looking for the treatment of the disease at any cost and there is a race in the market to provide treatment and make money, whether it is effective or not! In such a condition, many fraud products, remedies, and myths have come into the market, which is falsely claimed to be effective for the disease and can harm the patients. Hence, FDA has banned such products and remedies. In this review, we have compiled all such fraudulent and pseudosciences identified for COVID-19. Currently, in the pandemic time, health agencies are approving the repurposed medicines based on the small-scale clinical data for emergency uses that become ineffective (most of the cases) after large randomized clinical studies. Proper vigilance strategies need to be defined by the regulatory agencies of the nation and routine awareness programs shall be arranged for educating the people and healthcare workers on routine updates.

Beliefs, barriers and hesitancy towards the COVID-19 vaccine among Bangladeshi residents: Findings from a cross-sectional study

Background

COVID‐19 vaccination acceptance is important, and combating hesitancy which is generally based on the individuals’ beliefs and perceptions is essential in the present pandemic. This study assesses COVID‐19 vaccine hesitancy and associated factors, beliefs and barriers associated with COVID-19 vaccination.

Methods

A cross-sectional study was carried out among 492 Bangladeshi residents (76% male; mean age = 24.21 ± 4.91 years; age range = 18–50 years) prior to the nationwide mass COVID-19 vaccination campaign (September 28, 2021). A semi-structured e-questionnaire included three sections (demographic variables, beliefs around the vaccination, and perceived barriers regarding COVID-19 vaccination).

Results

More than a quarter of participants (26.42%) were hesitant, 70.33% reported to accept the vaccine, and 3.25% refused to be vaccinated. While (54%) believed that mass vaccination would be the most effective method to combat the COVID-19 pandemic, concerns regarding the side effects of the vaccine (58%), inadequate vaccine trials before human administration (43%), commercial profiteering (42%), and mistrust of the benefits of the vaccine (20%) were also reported. In addition, other barriers including a short supply of vaccines, unknown future adverse effects (55%), low confidence in the health system (51%), doubts regarding its effectiveness (50%) and safety (45%), and insufficient information regarding potential adverse effects (44.7%) were reported. In bivariate analysis, variables such as current political affiliation, previous vaccination history, and health status were significantly associated with the COVID-19 vaccine uptake variable (acceptance, hesitancy, refusal). Regression analysis showed that participants who identified with the opposing current political parties, and not having been vaccinated since the age of 18 years were significantly more likely to report vaccine hesitancy.

Conclusions

The current findings relating to COVID-19 vaccination demonstrate that government and policy makers need to take all necessary measures to ensure the effectiveness of the vaccination program among the Bangladeshi people.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy among Bangladeshi people: a cross-sectional study

Although vaccines are the most effective tool for preventing infectious disease, COVID-19 vaccination coverage among Bangladeshi mass people was facing challenges because large proportions were hesitant to accept a new vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to explore the potential factors influencing vaccine acceptance and hesitancy among the Bangladeshi people. A bilingual, self-administered anonymous questionnaire was developed and deployed and mixed-mode approaches (face-to-face and on-line survey) in data collection procedure were applied from 03rd May to 20th June, 2021. In total, 782 Bangladeshi people were participated in this study through random and snowballing sampling technique. Descriptive statistics and binary logistic regression analysis was employed to explore and rationalize the study objectives. Empirical findings revealed that, 69.4% (95% CI 66.1–72.7) respondents had the hesitation to accept newly promoted vaccines. The binary analysis revealed that, “safety” and “efficacy” had highly significant (p < 0.01) and positive association with vaccine acceptance. “Communication” had positive and moderately significant (p < 0.05) association; “culture” had positive and significant (p < 0.1) association while “rumor” associated moderate significantly (p < 0.05) and negatively with COVID-19 vaccine acceptance. According to the Pearson’s Chi-Square test, male had highly significant (p < 0.01) willingness to receive vaccines than female gender (OR = 0.501). The prevalence of COVID-19 vaccine hesitancy could be minimized by providing vaccine safety, side effect and, efficacy data to the community through effective communication. Health awareness campaign in remote areas would remove anti-vaccination beliefs and rumors; thus foster COVID-19 vaccine confidence among the culturally motivated Bangladeshi people.

Exploring COVID-19 Vaccine Confidence with People from Black and Asian Backgrounds in England

Aims

Little research has examined factors underlying COVID-19 vaccine hesitancy or refusal in Black and Asian individuals in England, among whom hesitancy tends to be higher than in the general population. This qualitative study aimed to gain an understanding of factors affecting hesitancy in Black and Asian individuals in England, to help address concerns about having the vaccine.

Method

Ninety-five participants (51 women, 42 men, 2 other; 58% were aged between 30 and 49) recruited via a market recruitment agency, local Healthwatch networks, and using a snowballing method, participated in four activities on an online engagement platform, sharing their attitudes towards the COVID-19 vaccine roll-out, and factors shaping their beliefs and concerns, over 5 weeks from April to March 2021.

Results

Inductive thematic analysis revealed five themes: (1) a variety of views on the COVID-19 vaccine, (2) targeted messaging for Black and Asian people as counterproductive, (3) confusion over the purpose of the vaccine roll-out, (4) hesitancy to take the vaccine, and (5) local networks as a trusted source of information.

Conclusions

Our findings suggest that respecting individuals’ agency, transparency of information provided, and the independence of the bodies providing this information are important. Instead of targeted messaging, local networks should be used in campaigns to increase COVID-19 vaccine uptake among Black and Asian individuals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-022-01372-w.

Anti-Vaccine Attitudes among Adults in the U.S. during the COVID-19 Pandemic after Vaccine Rollout

Even though vaccination is the most effective measure against COVID-19 infections, vaccine rollout efforts have been hampered by growing anti-vaccine attitudes. Based on current knowledge, we identified three domains (beliefs, discrimination, and news) as our correlates of primary interest to examine the association with anti-vaccine attitudes. This is one of the first studies to examine key correlates of anti-vaccine attitudes during the critical early stages of vaccine implementation in the United States. An online survey was administered in May 2021 to a non-representative, nationally based sample of adults (N = 789). Using multivariable logistic regression analysis, we found that individuals who expressed worry about COVID-19 (OR = 0.34, 95% CI 0.21, 0.55) and had greater knowledge of COVID-19 (OR = 0.50, 95% CI 0.25, 0.99) were less likely to hold anti-vaccine attitudes. Conversely, individuals who held stigmatizing views of COVID-19 (OR = 2.47, 95% CI 1.53, 3.99), had experienced racial discrimination (OR = 2.14, 95% CI 1.25, 3.67) and discrimination related to COVID-19 (OR = 2.84, 95% CI 1.54, 5.24), and who had been watching Fox News (OR = 3.95, 95% CI 2.61, 5.97) were more likely to hold anti-vaccine attitudes. These findings suggest COVID-19 beliefs, experiences of discrimination, and news sources should be considered when designing targeted approaches to address the anti-vaccine movement.

Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland

COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood.

Frequency and Nuisance Level of Adverse Events in Individuals Receiving Homologous and Heterologous COVID-19 Booster Vaccine

This study aimed to compare the occurrence and nuisance of adverse events following administration of each COVID-19 vaccine dose between two groups: individuals given three doses of mRNA vaccine (homologous group, 3 × mRNA, n = 252) and those given two doses of adenoviral vector vaccine further boosted with mRNA vaccine (heterologous group, 2 × AZ + 1 × mRNA, n = 205). Although the studied groups differed significantly in the frequency and number of side effects after the first and second vaccine dose, no relevant differences were seen following the booster administration. Arm pain and fatigue were the most common effects, regardless of the vaccination group and vaccine dose. In the homologous group, female sex, lower BMI, and no history of regular influenza vaccination were associated with a higher frequency of side effects of a booster dose. In the heterologous group, the history of COVID-19 was associated with an increased number of side effects seen after a booster. In both groups, the number of side effects related to the first and second dose correlated with the number observed after administration of a booster dose. Individuals receiving a homologous booster reported a higher nuisance of side effects than the heterologous group. It was similar to the level reported after the second dose in both groups. The use of pharmaceuticals to counteract the side effects was more frequent after a first dose in the 2 × AZ + 1 × mRNA group, but higher after second dose in individuals receiving the 3 × mRNA vaccination scheme. The frequency of pharmaceutical use after a booster dose was similar in both groups (approx. 60%). Paracetamol was most frequently chosen, regardless of the group and vaccine dose. In addition, the vast majority of participants (93%) declared to accept future doses of the COVID-19 vaccine if their administration would be recommended. This study provides an overview of the response to homologous and heterologous mRNA vaccine booster dose that may be valuable in shaping accurate and honest communication with vaccinated individuals, especially in those regions which are yet to pursue booster strategies.

The use of motivational interviewing to overcome COVID-19 vaccine hesitancy in primary care settings

Vaccine hesitancy is not a new phenomenon. However, the COVID-19 pandemic has highlighted the impact of political, racial, and health disparities on vaccine hesitancy at a global level. With the creation of the COVID-19 vaccine, a resurgence of vaccine hesitancy has emerged and many are reluctant to receive the vaccination. The reluctance varies from concerns about government interference in vaccine development, to the speed of vaccine development, to long-term health outcomes and potential side effects. Health care professionals need to consider evidence-based approaches that are effective in assisting patients with health care decision-making regarding vaccine uptake. Motivational Interviewing (MI) is an effective technique to positively impact behavior change. Definitions and examples of MI techniques are provided to illustrate how MI can be used to support patient autonomy and provide a safe and trusting environment, with the goal of increasing COVID-19 vaccination uptake.

Mis-Dis Information in COVID-19 Health Crisis: A Narrative Review

Background: In this narrative review, we address the COVID-19 pandemic mis–dis information crisis in which healthcare systems have been pushed to their limits, with collapses occurring worldwide. The context of uncertainty has resulted in skepticism, confusion, and general malaise among the population. Informing the public has been one of the major challenges during this pandemic. Misinformation is defined as false information shared by people who have no intention of misleading others. Disinformation is defined as false information deliberately created and disseminated with malicious intentions. Objective: To reach a consensus and critical review about mis–dis information in COVID-19 crisis. Methods: A database search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase and CinAhl. Databases used the MeSH-compliant keywords of COVID-19, 2019-nCoV, Coronavirus 2019, SARS-CoV-2, misinformation, disinformation, information, vaccines, vaccination, origin, target, spread, communication. Results: Both misinformation and disinformation can affect the population’s confidence in vaccines (development, safety, and efficacy of vaccines, as well as denial of the severity of SARS-CoV infection). Institutions should take into account that a great part of the success of the intervention to combat a pandemic has a relationship with the power to stop the misinformation and disinformation processes. The response should be well-structured and addressed from different key points: central level and community level, with official and centralized communication channels. The approach should be multifactorial and enhanced by the collaboration of social media companies to stop misleading information, and trustworthy people both working or not working in the health care systems to boost the power of the message. Conclusions: The response should be well-structured and addressed from different key points: central level and community level, with official and clearly centralized communication channels. The approach should be multifactorial and enhanced from the collaboration of social media companies to stop misleading information, and trustworthy people both working and not working in the health care systems to boost the power of a message based on scientific evidence.

What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany

Background

Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites.

Methods

The German-language versions of Instagram, Twitter and YouTube were searched regarding negative attitudes towards COVID-19 vaccination. Data was extracted until a saturation effect could be observed. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the general availability of vaccines against COVID-19 in Germany. We used an interpretive thematic approach to analyze the data and to inductively generate codes, subcategories and categories.

Results

Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination.

Conclusions

The study emphasizes the relevance of providing trustworthy and quality-assured information on COVID-19 and COVID-19 vaccination to all population groups. In addition, vaccinations should be easily accessible in order to promote the population’s willingness to be vaccinated.

Acceptance or Rejection of the COVID-19 Vaccine: A Study on Iranian People's Opinions toward the COVID-19 Vaccine

We aimed to assess the Iranian people’s attitude and confidence in the COVID-19 vaccine, their concerns about the safety of vaccines, and their reasons for accepting or rejecting the COVID-19 vaccine. We conducted a web-based cross-sectional study with a mixed qualitative−quantitative approach from December 2020 to February 2021. Our questionnaire consisted of a COVID-19 vaccine attitude questionnaire, a COVID-19 vaccine confidence inventory, a modified vaccine safety scale, and questions about participants’ decision to accept or refuse the COVID-19 vaccine, and their explanations for their decisions. The research included 1928 people with an average age of 34.88 years with 1236 (64.1%) being female. A total of 1330 participants desired to have the COVID-19 vaccine (69%). Female gender, lower educational levels, following COVID-19 news through sources other than websites and social media, not following COVID-19 news, and loss of a first-degree relative due to COVID-19 were all associated with a more negative attitude toward the COVID-19 vaccine (p < 0.01). To conclude, the acceptance rate of the COVID-19 vaccine among Iranians is comparable to the international average; however, it is still unfavorable. There are serious challenges to the vaccination program in Iran, such as older adults’ lower intention to undergo the COVID-19 vaccine and misinformation.

High COVID-19 Vaccine Acceptance among Eye Healthcare Workers in Uganda

Background: Protecting healthcare workers against COVID-19 disease is crucial, and COVID-19 vaccination is the most effective method to do so. Eye healthcare workers provide routine care in proximity, increasing infection risk, hence their need for full vaccination. This study determined COVID-19 vaccine acceptance and barriers to its uptake among eye healthcare workers practicing in Uganda. Methods: This was a cross-sectional online and telephone survey based on the health belief model (HBM), conducted in June–August 2021. A modified Poisson regression model with robust standard errors was used to determine the factors associated with COVID-19 vaccine acceptance. Results: In total, 300 (85%) of the 357 eye healthcare workers participated in the study with mean age 43 ± 8 years and 182 (60.7%) were men. Overall, 97.6% (95% CI: 95.9–99.4) had accepted and/or were willing to take the COVID-19 vaccine, 65.3% had received a shot of the COVID-19 vaccine, and 97 (32.3%) reported the intention to accept the vaccine when it became available. Among the HBM constructs, high perceived susceptibility and high perceived benefits were significantly associated with COVID-19 vaccine acceptance. Conclusions: The acceptance of the COVID-19 vaccine among eye healthcare workers in Uganda is very high. There is a dire need to make vaccines available to developing nations like Uganda.

Severe Breakthrough COVID-19 Cases during Six Months of Delta Variant (B.1.617.2) Domination in Poland

The emergence of a highly transmissible and a more pathogenic B.1.617.2 (delta) variant of SARS-CoV-2 has brought concern over COVID-19 vaccine efficacy and the increased risk of severe breakthrough infections. The objective of this study was to assess the frequency and the clinical characteristics of severe breakthrough COVID-19 cases recorded in 10 Polish healthcare units between 1 June and 31 December 2021, a period during which a rapid surge in the share of B.1.617.2 infections was seen, while a significant number of populations were already fully vaccinated. Overall, 723 individuals who completed the initial vaccination regime (fully vaccinated group) and an additional 18 who received a booster dose were identified—together, they represented 20.8% of all the COVID-19 patients hospitalized during the same period in the same healthcare institutions (0.5% in the case of a group that received a booster dose). Although laboratory and clinical parameters did not differ between both groups, patients who received a booster tended to have lower CRP, IL-6, PCT, and d-dimer levels and they required oxygen therapy less frequently. The most common early COVID-19 symptoms in the studied group were fatigue, cough, fever (>38 °C), and dyspnea. Individuals with no detectable anti-spike IgG antibodies constituted 13%; the odds of being a humoral non-responder to the vaccine were increased in patients aged >70 years. Fully vaccinated patients hospitalized after more than 180 days from the last vaccine dose were significantly older and they were predominantly represented by individuals over 70 years and with comorbidities, particularly cardiovascular disease. Contrary to mRNA vaccines, most patients vaccinated with adenoviral vector vaccines were infected within six months. A total of 102 fatal cases (14% of all deaths among vaccinated individuals; 0.7% in the case of a group that received a booster dose) were recorded, representing 17.6% of all the COVID-19 fatalities recorded in June−December 2021 in the considered healthcare units. The odds of death were significantly increased in men, individuals aged >70 years, patients with comorbidities, and those identified as humoral non-responders to vaccination; in fully vaccinated patients the odds were also increased when the second vaccine dose was given >180 days before the first COVID-19 symptoms. The mortality rate in immunocompromised subjects was 19%. The results indicate that compared to vaccinated individuals, severe COVID-19 and deaths in the unvaccinated group were significantly more prevalent during the B.1.617.2-dominated wave in Poland; and, it highlight the protective role of a booster dose, particularly for more vulnerable individuals.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review

BACKGROUND AND AIMS

Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count.

METHODS

A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review.

RESULTS

In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States.

CONCLUSIONS

The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.

Does Hospitalization Change the Perception of COVID-19 Vaccines among Unvaccinated Patients?

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

Using qualitative research to develop an elaboration of the TIDieR checklist for interventions to enhance vaccination communication: short report

Background

The COVID-19 pandemic has led to an increased interest in communication with the public regarding vaccination. Our recent Cochrane qualitative evidence synthesis points to several factors that could influence the implementation and success of healthcare worker communication with older adults about vaccination. However, it is often difficult to assess whether factors identified as potentially important in qualitative studies have been considered in randomized trials because of poor trial reporting. We therefore decided to use our qualitative evidence synthesis findings to encourage better reporting of vaccination communication interventions in trials by developing an elaboration of the TIDieR (Template for Intervention Description and Replication) checklist for intervention reporting.

Methods

We examined the findings from our Cochrane qualitative evidence synthesis on healthcare workers’ perceptions of and experiences with communicating about vaccination with adults over the age of 50 years. We identified factors that could influence the implementation and uptake, and thereby the effectiveness, of vaccination communication interventions. We then drafted a list of the information elements we would need from trial reports to assess whether these factors had been considered in the development of the interventions evaluated in these trials. Finally, we compared our list of information elements to the TIDieR checklist items. We were able to align all of our information elements with the TIDieR items. However, for several of the TIDieR items, we developed a more detailed description to ensure that relevant information would be captured sufficiently in trial reports.

Results

We developed elaborations for the following TIDieR items: “Why” (item 2), “What—materials” (item 3), “Who provided” (item 5), “How” (item 6), “Where” (item 7) and “Tailoring” (item 9).

Conclusions

Both qualitative research and trials of intervention effectiveness are critical to furthering our understanding of what works, where, for whom and through which mechanisms. However, a key ingredient for developing this understanding is adequate reporting of intervention design, content and implementation in randomized trials. We hope that this elaboration of the TIDier checklist will improve reporting of interventions in trials focused on vaccine communication with older adults, and thereby enhance the usability of this research for developing future communication strategies.

COVID-19 Vaccination and Rates of Infections, Hospitalizations, ICU Admissions, and Deaths in the European Economic Area during Autumn 2021 Wave of SARS-CoV-2

The COVID-19 vaccination campaigns were met with a varying level of vaccine hesitancy in Europe. We analyzed the potential relationships between COVID-19 vaccine coverage in different countries of the European Economic Area and rates of infection, hospitalizations, admissions to intensive care units (ICU), and deaths during the autumn 2021 SARS-CoV-2 wave (September−December). Significant negative correlations between infection rates and the percentage of fully vaccinated individuals were found during September, October, and November, but not December. The loss of this protective effect in December is likely due to the emergence of the omicron (B.1.1.529) variant, better adapted to evade vaccine-induced humoral immunity. For every considered month, the negative linear associations between the vaccine coverage and mean number of hospitalizations (r= −0.61 to −0.88), the mean number of ICU admissions (r= −0.62 to −0.81), and death rate (r= −0.64 to −0.84) were observed. The results highlight that vaccines provided significant benefits during autumn 2021. The vaccination of unvaccinated individuals should remain the primary strategy to decrease the hospital overloads, severe consequences of COVID-19, and deaths.

Misinformation versus Facts: Understanding the Influence of News regarding COVID-19 Vaccines on Vaccine Uptake

Background

There is a lot of fact-based information and misinformation in the online discourses and discussions about the COVID-19 vaccines.

Method

Using a sample of nearly four million geotagged English tweets and the data from the CDC COVID Data Tracker, we conducted the Fama-MacBeth regression with the Newey-West adjustment to understand the influence of both misinformation and fact-based news on Twitter on the COVID-19 vaccine uptake in the US from April 19 when US adults were vaccine eligible to June 30, 2021, after controlling state-level factors such as demographics, education, and the pandemic severity. We identified the tweets related to either misinformation or fact-based news by analyzing the URLs.

Results

One percent increase in fact-related Twitter users is associated with an approximately 0.87 decrease (B = -0.87, SE = 0.25, and p < .001) in the number of daily new vaccinated people per hundred. No significant relationship was found between the percentage of fake-news-related users and the vaccination rate.

Conclusion

The negative association between the percentage of fact-related users and the vaccination rate might be due to a combination of a larger user-level influence and the negative impact of online social endorsement on vaccination intent.

Addressing COVID-19 Vaccine Acceptance Within a Large Healthcare System: a Population Health Model

BACKGROUND

The COVID-19 pandemic, and vaccine hesitancy, pose a significant public health threat. The Veterans Health Administration system is uniquely situated to provide insights into the implementation of a population health approach to vaccine acceptance.

AIM

We describe the VA Connecticut Healthcare System's (VACHS) quality improvement project to improve rates of vaccine uptake.

SETTING AND PARTICIPANTS

VACHS consists of eight primary care sites with 80 primary care providers delivering care to 47,000 enrolled veterans.

PROGRAM DESCRIPTION

Our program involved identification of a local champion, education sessions, development of vaccine acceptance tools (including the templated "COVID-19 Prevention Letter" and the "COVID-19 Prevention Telephone Note"), and application of a population health approach (use of a prioritization scheme and playbook) by primary care patient-aligned care (PACT) medical home teams.

PROGRAM EVALUATION

We found increased rates of vaccination at VACT compared to the surrounding region 6 months after implementation (65.16% vs 61.89%). Use of vaccine acceptance tools were associated with a statistically significant increase in vaccination (24.1% vs 13.6%, P = 0.036) in unvaccinated veterans.

DISCUSSION

A population health approach to vaccine acceptance using EHR-based tools can impact vaccination rates, and this approach may be of practical utility to other large healthcare systems with EHR.

Reported Adverse Effects and Attitudes among Arab Populations Following COVID-19 Vaccination: A Large-Scale Multinational Study Implementing Machine Learning Tools in Predicting Post-Vaccination Adverse Effects Based on Predisposing Factors

Background: The unprecedented global spread of coronavirus disease 2019 (COVID-19) has imposed huge challenges on the healthcare facilities, and impacted every aspect of life. This has led to the development of several vaccines against COVID-19 within one year. This study aimed to assess the attitudes and the side effects among Arab communities after receiving a COVID-19 vaccine and use of machine learning (ML) tools to predict post-vaccination side effects based on predisposing factors. Methods: An online-based multinational survey was carried out via social media platforms from 14 June to 31 August 2021, targeting individuals who received at least one dose of a COVID-19 vaccine from 22 Arab countries. Descriptive statistics, correlation, and chi-square tests were used to analyze the data. Moreover, extensive ML tools were utilized to predict 30 post vaccination adverse effects and their severity based on 15 predisposing factors. The importance of distinct predisposing factors in predicting particular side effects was determined using global feature importance employing gradient boost as AutoML. Results: A total of 10,064 participants from 19 Arab countries were included in this study. Around 56% were female and 59% were aged from 20 to 39 years old. A high rate of vaccine hesitancy (51%) was reported among participants. Almost 88% of the participants were vaccinated with one of three COVID-19 vaccines, including Pfizer-BioNTech (52.8%), AstraZeneca (20.7%), and Sinopharm (14.2%). About 72% of participants experienced post-vaccination side effects. This study reports statistically significant associations (p < 0.01) between various predisposing factors and post-vaccinations side effects. In terms of predicting post-vaccination side effects, gradient boost, random forest, and XGBoost outperformed other ML methods. The most important predisposing factors for predicting certain side effects (i.e., tiredness, fever, headache, injection site pain and swelling, myalgia, and sleepiness and laziness) were revealed to be the number of doses, gender, type of vaccine, age, and hesitancy to receive a COVID-19 vaccine. Conclusions: The reported side effects following COVID-19 vaccination among Arab populations are usually non-life-threatening; flu-like symptoms and injection site pain. Certain predisposing factors have greater weight and importance as input data in predicting post-vaccination side effects. Based on the most significant input data, ML can also be used to predict these side effects; people with certain predicted side effects may require additional medical attention, or possibly hospitalization.

How Does Social Media Influence People to Get Vaccinated? The Elaboration Likelihood Model of a Person's Attitude and Intention to Get COVID-19 Vaccines

The global COVID-19 mass vaccination program has created a polemic amongst pro- and anti-vaccination groups on social media. However, the working mechanism on how the shared information might influence an individual decision to be vaccinated is still limited. This study embarks on adopting the elaboration likelihood model (ELM) framework. We examined the function of central route factors (information completeness and information accuracy) as well as peripheral route factors (experience sharing and social pressure) in influencing attitudes towards vaccination and the intention to obtain the vaccine. We use a factorial design to create eight different scenarios in the form of Twitter posts to test the interaction and emulate the situation on social media. In total, 528 respondents were involved in this study. Findings from this study indicated that both the central route and peripheral route significantly influence individually perceived informativeness and perceived persuasiveness. Consequently, these two factors significantly influence attitude towards vaccination and intention to obtain the vaccine. According to the findings, it is suggested that, apart from evidence-based communication, the government or any interested parties can utilize both experience sharing and social pressure elements to increase engagement related to COVID-19 vaccines on social media, such as Twitter.

Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia

OBJECTIVE

Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine.

METHOD

In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations.

RESULTS

Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.

COVID-19: A pluralistic and integrated approach for efficient management of the pandemic

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which triggered the ongoing pandemic, was first discovered in China in late 2019. SARS-CoV-2 is a respiratory virus responsible for coronavirus disease 2019 (COVID-19) that often manifests as a pneumonic syndrome. In the context of the pandemic, there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients. In addition, the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases. This raises the issue of the complexity of the work required to control or contain the pandemic. We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge. This paper proposes a comprehensive and integrative approach to COVID-19 research, prevention, control, and treatment to better address the pandemic. Thus, this literature review applies a pluralistic approach to fight the pandemic.