A Comparison of Vaccine Hesitancy of COVID-19 Vaccination in China and the United States

Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments

BACKGROUND

Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide.

OBJECTIVE

We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments.

METHODS

A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist.

RESULTS

The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes.

CONCLUSIONS

Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time.

TRIAL REGISTRATION

PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7.

Employees' seeking preference towards influenza vaccination in organization: A discrete choice experiment in China

To clarify the preferences of employees seeking influenza vaccination, a discrete choice experiment aims to understand the essential factors that close the gap between intention and behavior. A total of 866 employees with vaccination willingness willing to participated in a discrete choice experiment (DCE) between October 31st and December 6th, 2022 in China including the following attributes: price, vaccination setting, appointment mode, and service time. The data was analyzed using mixed logit models. Employees from smaller enterprises were more likely to get vaccinated collectively. For employees willing to get the influenza vaccine, 95.08 % of their choice was dominated by price. Employees' behavior varied according to their socioeconomic characteristics. Only female employees strongly favored work-site-based vaccination. Price was the primary factor considered by employees for getting the influenza vaccine. DCE would help to develop influenza vaccination intervention targeted at different groups in future studies.

Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment

OBJECTIVES

The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance.

METHODS

A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL.

RESULTS

A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19.

CONCLUSIONS

Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines.

PATIENT OR PUBLIC CONTRIBUTION

A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.

How Mortality Salience and Self-Construal Make a Difference: An Online Experiment to Test Perception of Importance of COVID-19 Vaccines in China

To better understand why Chinese residents' COVID-19 perceptions of the importance of vaccination change dramatically over time, this research used an online lab-like experiment to test the antecedents of individuals' perception of the importance of COVID-19 vaccines. We find that participants who view themselves as separate from others (i.e. independent self-construal) perceive COVID-19 vaccines as more important than Hepatitis B vaccines (i.e. control group), regardless of how salient mortality is for them. In contrast, among participants who view themselves as a part of their social groups (i.e. interdependent self-construal), awareness of death (i.e. mortality salience) plays a moderating role. Specifically, when mortality is salient, COVID-19 vaccines are considered more important than Hepatitis B vaccines; when morality is not salient, vaccine type does not make a difference on perceptions of vaccine importance.

Factors associated with COVID-19 vaccine uptake among foreign migrants in China

Background/Purpose

The COVID-19 outbreak created unique policy challenges for vaccinating special groups like migrants. As part of sustainable development goals, the equitable distribution of the COVID-19 vaccine can contribute to ensuring health for all. This study examined COVID-19 vaccine uptake among foreign migrants in China based on sociodemographics, cultural beliefs, past vaccine behaviors, and psychosocial factors.

Design

An online cross-sectional survey was conducted among foreign migrants in mainland China via social media platforms from 21 November through 20 December 2021. Bivariate (unadjusted odd-ratio) and multivariate logistic regression analyses were performed to establish the correlates of COVID-19 vaccine uptake.

Result

Surveyed foreign migrants that are culture neutral (AOR: 2.5, CI: 95%, 1.02-5.90, p = 0.044), willing to pay for vaccination (AOR: 2.27, CI: 95%, 1.18-3.98, p = 0.012), believe in vaccine efficacy (AOR: 3.00, CI: 95%, 1.75-5.16, p < 0.000), have poor psychological health (AOR: 1.96, CI: 95%, 1.14-3.38, p = 0 0.014), and have higher perceived seriousness of COVID-19 (AOR: 2.12, CI: 95%, 1.26-3.57, p = 0.005) are more likely to receive COVID-19 vaccine. Those migrants with a history of declining vaccination (AOR: 0.34, CI: 95%, 0.18-0.65, p = 0.000) and middle-income earners $1701-3500 (AOR: 0.43, CI: 95%, 0.23-0.82, p = 0.010) are less likely to receive the COVID-19 vaccine.

Conclusion

This study brings a unique perspective to understanding vaccine behavior among international migrants in China. There is an urgent call from the World Health Organization and countries for complete vaccination and efforts to improve vaccine coverage. However, fewer studies have been conducted globally on the vaccination of migrant populations. The current study provides empirical information to increase the knowledge of the correlates of vaccine behavior among immigrants in countries around the globe. Future studies should conduct cross-country comparisons to understand the factors associated with increasing vaccination rates among immigrant populations to formulate a strong policy to increase vaccine coverage among immigrant populations across countries.

Parental hesitancy against COVID-19 vaccination for children and associated factors in Taiwan

Background

Since July 2021, some countries and regions have initiated the vaccination of minors against coronavirus disease (COVID-19), and parental COVID-19 vaccine hesitancy will affect the vaccination of minors. We aimed to identify the level of parental hesitancy to vaccinate their children against COVID-19 in Taiwan and the factors associated with vaccine hesitancy.

Methods

We conducted a population-based, self-administered online questionnaire in Taiwan to assess parental hesitancy and the factors influencing their children’s vaccination against COVID-19.

Results

Among 384 respondents, 64.1% were hesitant to have their children vaccinated against COVID-19. Mothers were more likely to hesitate to vaccinate their teens than their fathers (67.5% vs. 50%, P < 0.005). Multiple regression results showed that parents who were hesitant to vaccinate themselves (OR = 3.81, 95% CI:2.07–7.02) and those who scored lower on their perception of their children’s vaccination (OR = 9.73, 95% CI:5.62–16.84) were more hesitant to vaccinate their children with COVID-19 vaccine.

Conclusions

According to the study findings, 64.1% of Taiwanese parents were hesitant to vaccinate their children against COVID-19. Parents who were hesitant to receive the COVID-19 vaccine for themselves and had negative views of the vaccine for their children were more likely to be hesitant to vaccinate their children. An in-depth discussion of the factors affecting vaccine hesitancy and targeted health education is conducive to promoting vaccination in children with COVID-19.

Understanding influencing attributes of COVID-19 vaccine preference and willingness-to-pay among Chinese and American middle-aged and elderly adults: A discrete choice experiment and propensity score matching study

Background and objective

COVID-19 has imposed burdens on public health systems globally. Owing to the urgency of vaccination, this study aimed at comparing the differences in preference and willingness to pay of COVID-19 vaccine among Chinese and American middle-aged and elderly adults.

Methods

A cross-sectional survey containing demographic questions, rating their acceptance of COVID-19 vaccination with and without recommendations from friends, family members or employers (the social cues referred to in our study), and a discrete choice experiment understanding COVID-19 vaccine preference and willingness to pay was conducted to collect data. Propensity score matching was utilized to adjust confounding factors of baseline characteristics and the relative importance of respondents' preference for each attribute and its level was estimated using a conditional logit model. Then, willingness to pay was calculated.

Results

In total, 3,494 (2,311 and 1,183 from China and the United States, respectively) completed the questionnaire, among which 3,444 questionnaires were effective. After propensity score matching, 1,604 respondents with 802 from the US and 802 from China were included. Under the influence of the social cues, Chinese respondents' vaccine acceptance decreased from 71.70 to 70.70%, while American respondents' vaccine acceptance increased from 74.69 to 75.81%. The discrete choice experiment showed that American respondents regarded the efficacy of COVID-19 vaccine as the most important attribute, whereas Chinese respondents attached the highest importance to the cost of vaccination. But overall, the COVID-19 vaccine with the higher efficacy, the milder adverse effect, the lower cost, and the longer duration will promote the preference of the public in both countries. Additionally, the public were willing to spend the most money for a reduction in COVID-19 vaccine adverse effect from moderate to very mild (37.476USD for the United States, 140.503USD for China), followed by paying for the 1% improvement in its efficacy and paying for the one-month extension of its duration.

Conclusion

Given the impact of social cues on vaccine acceptance, Chinese government should promote reasonable vaccine-related information to improve national vaccination acceptance. Meanwhile, considering the influence of COVID-19 attributes on public preference and willingness to pay, regulating the vaccine pricing, improving the efficacy of the vaccine, reducing its adverse effect, and prolonging the duration of the vaccine works will contribute to vaccine uptake.

The Role of Remote Sensing and Geospatial Analysis for Understanding COVID-19 Population Severity: A Systematic Review

Remote sensing (RS), satellite imaging (SI), and geospatial analysis have established themselves as extremely useful and very diverse domains for research associated with space, spatio-temporal components, and geography. We evaluated in this review the existing evidence on the application of those geospatial techniques, tools, and methods in the coronavirus pandemic. We reviewed and retrieved nine research studies that directly used geospatial techniques, remote sensing, or satellite imaging as part of their research analysis. Articles included studies from Europe, Somalia, the USA, Indonesia, Iran, Ecuador, China, and India. Two papers used only satellite imaging data, three papers used remote sensing, three papers used a combination of both satellite imaging and remote sensing. One paper mentioned the use of spatiotemporal data. Many studies used reports from healthcare facilities and geospatial agencies to collect the type of data. The aim of this review was to show the use of remote sensing, satellite imaging, and geospatial data in defining features and relationships that are related to the spread and mortality rate of COVID-19 around the world. This review should ensure that these innovations and technologies are instantly available to assist decision-making and robust scientific research that will improve the population health diseases outcomes around the globe.

The Naturalness Bias Influences Drug and Vaccine Decisions across Cultures

HIGHLIGHTS

The naturalness bias - preferring natural to synthetic drugs or vaccines - occurred across cultures (Americans, Canadians, and Chinese).Chinese participants showed a stronger naturalness bias than Americans did when the medical context was focused on vaccination, and safety concerns mediated this effect.The naturalness bias may influence medical decision making across cultures, but Chinese participants may be more sensitive to naturalness in a vaccine context.

Hesitation about coronavirus vaccines in healthcare professionals and general population in Spain

BACKGROUND

This study attempts to provide a picture of the hesitancy to vaccination against COVID-19 in Spain during the 2021 spring-autumn vaccination campaign, both in the general population and in healthcare professionals.

METHODS

The participants were recruited using social media such as Facebook and Twitter, in addition to the cooperation of health personnel contacted with the collaboration of medical scientific societies. A cross-sectional study was carried out that included the response of an online questionnaire. The data were collected from April 30 to September 26, 2021. To assess the different associations between variables to be measured, we fit Poisson regression models with robust variance.

RESULTS

Responses were obtained from 3,850 adults from the general population group and 502 health professionals. Of the overall sample, 48.6% of participants from the general population were vaccinated against COVID-19, whereas in the healthcare professionals, 94.8% were vaccinated. The prevalence of general population vaccination increased with age, and was higher in women than men. Most participants did not show a preference for any vaccine itself. However, the prevalence of people vaccinated with their preferred vaccine was higher for the ones vaccinated with Pfizer's vaccine. 6.5% of the general population reported being reticent to be vaccinated. People from younger age groups, people with lower educational levels and those who were not from a risk group showed greater reluctance to be vaccinated. No gender differences in reluctancy were found.

CONCLUSIONS

Health professionals were significantly less likely to refuse vaccination even though they had more doubts about the safety and efficacy of vaccines. On the other hand, younger people, those with a lower level of education and those who were not from a risk group were the most hesitant.

Impact of Media Use on Chinese Public Behavior towards Vaccination with the COVID-19 Vaccine: A Latent Profile Analysis

(1) Background: research on vaccines has received extensive attention during epidemics. However, few studies have focused on the impact of media use on vaccination behavior and the factors influencing vaccination in groups with different media use degrees; (2) Method: Based on seven items related to media use, a total of 11,031 respondents were categorized by the frequency of media use by using latent profile analysis (LPA). Binary regression analysis was used to study the factors that influence the vaccination behaviors of people with different media use frequencies; (3) Results: All respondents were classified into the following three groups: media use low frequency (9.7%), media use general (67.1%), and media use high frequency (23.2%). Media use low frequency (β = −0.608, p < 0.001) was negatively associated with COVID-19 vaccination behavior. In the media use low frequency, analysis showed that “aged 41 years or older” β = 1.784, p < 0.001), had religious belief (β = 0.075, p < 0.05), were ethnic minorities (β = 0.936, p < 0.01) and had friends support (β = 0.923, p < 0.05) were associated with a preference to accept the COVID-19 vaccine. In the media use general, those who aged 41 years old and older (β = 1.682, p < 0.001), had major depression (β = 0.951, p < 0.05), had friends support (β = 0.048, p < 0.001) would be more likely to receive COVID-19 vaccination. However, respondents who live in towns (β = −0.300, p < 0.01) had lower behaviors to receive vaccination for COVID-19. In the media use high frequency, the respondents who aged 41 or older (β = 1.010, p < 0.001), were ethnic minorities (β = 0.741, p < 0.001), had moderate depression (β = 1.003, p < 0.05) would receive the vaccination for COVID-19 positively; (4) Conclusions: The more occluded the media use is, the less likely the respondents are to get vaccinated against COVID-19. Vaccination behavior is influenced by different factors in groups with different frequencies of media use. Therefore, the government and appropriate departments should make individualized and targeted strategies about COVID-19 vaccination and disseminate the vaccination information to different media use groups.

Attitudes and Beliefs around the Value of Vaccination in the United States

Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals’ perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake.

Applications of discrete choice experiments in COVID-19 research: Disparity in survey qualities between health and transport fields

Published choice experiments linked to various aspects of the COVID-19 pandemic are analysed in a rapid review. The aim is to (i) document the diversity of topics as well as their temporal and geographical patterns of emergence, (ii) compare various elements of design quality across different sectors of applied economics, and (iii) identify potential signs of convergent validity across findings of comparable experiments. Of the N = 43 published choice experiments during the first two years of the pandemic, the majority identifies with health applications (n = 30), followed by transport-related applications (n = 10). Nearly 100,000 people across the world responded to pandemic-related discrete choice surveys. Within health applications, while the dominant theme, up until June 2020, was lockdown relaxation and tracing measures, the focus shifted abruptly to vaccine preference since then. Geographical origins of the health surveys were not diverse. Nearly 50% of all health surveys were conducted in only three countries, namely US, China and The Netherlands. Health applications exhibited stronger pre-testing and larger sample sizes compared to transport applications. Limited signs of convergent validity were identifiable. Within some applications, issues of temporal instability as well as hypothetical bias attributable to social desirability, protest response or policy consequentiality seemed likely to have affected the findings. Nevertheless, very few of the experiments implemented measures of hypothetical bias mitigation and those were limited to health studies. Our main conclusion is that swift administration of pandemic-related choice experiments has overall resulted in certain degrees of compromise in study quality, but this has been more so the case in relation to transport topics than health topics.

A Systematic Investigation of American Vaccination Preference via Historical Data

While COVID-19 vaccines are generally available, not all people receive vaccines. To reach herd immunity, most of a population must be vaccinated. It is, thus, important to identify factors influencing people’s vaccination preferences, as knowledge of these preferences allows for governments and health programs to increase their vaccine coverage more effectively. Fortunately, vaccination data were collected by U.S. Census Bureau in partnership with the CDC via the Household Pulse Survey (HPS) for Americans. This study presents the first analysis of the 24 vaccination datasets collected by the HPS from January 2021 to May 2022 for 250 million respondents of different ages, genders, sexual orientations, races, education statuses, marital statuses, household sizes, household income levels, and resources used for spending needs, and with different reasons for not receiving or planning to receive a vaccine. Statistical analysis techniques, including an analysis of variance (ANOVA), Tukey multiple comparisons test, and hierarchical clustering (HC), were implemented to analyze the HPS vaccination data in the R language. It was found that sexual orientation, gender, age, and education had statistically significant influences on the vaccination rates. In particular, the gay/lesbian group showed a higher vaccination rate than the straight group; the transgender group had a lower vaccination rate than either the female or the male groups; older respondents showed greater preference for vaccination; respondents with higher education levels also preferred vaccination. As for the other factors that were not significant enough to influence vaccinations in the ANOVA, notable trends were found. Asian Americans had higher vaccination rates than other races; respondents from larger household sizes had a lower chance of getting vaccinated; the unmarried group showed the lowed vaccination rate in the marital category; the respondents depending on borrowed money from the Supplemental Nutrition Assistance Program (SNAP) showed a lower vaccination rate than people with regular incomes. Concerns regarding the side-effects and the safety of the vaccines were the two major reasons for vaccination hesitance at the beginning of the pandemic, while having no trust in the vaccines and no trust in the government became more common in the later stage of the pandemic. The findings in this study can be used by governments or organizations to improve their vaccination campaigns or methods of combating future pandemics.

Perception of COVID-19 Booster Dose Vaccine among Healthcare Workers in India and Saudi Arabia

Background: COVID-19 vaccines were made available to the public by the end of 2020. However, little is known about COVID-19 booster dose (CBD) vaccine perception among healthcare workers (HCW) worldwide. The present study aims to assess the perception of CBD vaccines among healthcare workers in India and Saudi Arabia (SA). Methods: A cross-sectional study was conducted among HCWs in two countries, India and SA. Data were gathered through the use of a self-administered questionnaire. A convenience sampling technique was utilized to collect the data. Results: A total of 833 HCW responses were collected from the two countries, with 530 participants from India and 303 participants from SA responding to the questionnaire. Among them, 16% from India and 33% from SA were unwilling to take a CBD (p < 0.005). The primary reasons for not being willing were concerns about whether the vaccine would be effective (32%) and concerns about probable long-term side effects (31%). Concerns about not knowing enough about the vaccination (30%) and the possibility of long-term side effects (28%) were the primary concerns in SA. Regression analysis showed that males, urban residents, and post-graduates were more willing to take the CBD. Conclusion: There is a good perception of CBD and some hesitancy in receiving the booster dose among HCWs in both countries. The introduction of personalized education, risk communication, and deliberate policy could help to reduce the number of people who are unwilling to take a booster shot.

Behind the Scenes of COVID-19 Vaccine Hesitancy: Psychological Predictors in an Italian Community Sample

Psychological variables may be crucial in favoring or discouraging health-related behaviors, including vaccine acceptance. This study aimed to extend the previous literature by outlining the psychological profile associated with COVID-19 vaccine hesitancy in a sample of Italian citizens. Between April and May 2021, 1122 Italian volunteers completed a web survey on COVID-19 vaccine acceptance, also including several self-reported psychological measures. A multiple hierarchical logistic regression analysis was performed to identify the psychological variables associated with vaccine hesitancy. Low confidence in COVID-19 vaccine efficacy and safety, low collective responsibility, high complacency, and high calculation (i.e., extensive information searching, and costs–benefit estimates) predicted higher hesitancy. Our results suggest that to be effective, vaccine-related communications should be as clear, understandable, and sound as possible, preventing the spreading of misunderstandings, or even fake information, that may foster people’s insecurities and distrust. Furthermore, the advantages and necessity of vaccination, both at the individual and community-level, should be clearly emphasized. Efficacious vaccine-related communications may be crucial, not only to maintain an adequate immunity rate for COVID-19, but also to inform policymakers and public authorities in the case of possible future infectious outbreaks.

Incorporating Fuzzy Cognitive Inference for Vaccine Hesitancy Measuring

Vaccine hesitancy plays a key role in vaccine delay and refusal, but its measurement is still a challenge due to multiple intricacies and uncertainties in factors. This paper attempts to tackle this problem through fuzzy cognitive inference techniques. Firstly, we formulate a vaccine hesitancy determinants matrix containing multi-level factors. Relations between factors are formulated through group decision-making of domain experts, which results in a fuzzy cognitive map. The subjective uncertainty of linguistic variables is expressed by fuzzy numbers. A double-weighted method is designed to integrate the distinguished decisions, in which the subjective hesitancy is considered for each decision. Next, three typical scenarios are constructed to identify key and sensitive factors under different experimental conditions. The experimental results are further discussed, which enrich the approaches of vaccine hesitancy estimation for the post-pandemic global recovery.

Determining the Prevalence and Correlates of COVID-19 Booster Vaccine Hesitancy in the Singapore Population Following the Completion of the Primary Vaccination Series

In response to declining vaccine-induced immunity and the emergence of new COVID-19 variants, COVID-19 booster vaccination programmes have been widely launched in several high-income countries. However, public response has been slow, and scepticism about these programmes is rising in these settings. This study sought to identify the sociodemographic, emotional, and psychological factors associated with COVID-19 booster vaccine hesitancy in Singapore. Derived from a community cohort, 1005 fully vaccinated adults (62.1% female, mean age = 42.6 years) that had not received their COVID-19 booster shots completed an online survey between October and November 2021 on vaccination beliefs, intentions, and behaviours. Results indicated that despite completing the primary COVID-19 vaccination, 30.5% of those surveyed were hesitant about receiving the booster shot (25.9% unsure; 4.7% refused the booster), and 39.2% perceived more vaccine risks than benefits. Multivariable models indicated that a tertiary education, lower COVID-19 threat perception, lower perceived benefits, higher perceived concerns, a decreased need for booster vaccination, and a lower benefit/concerns differential score were associated with higher odds of booster vaccine hesitancy. Success in the primary vaccination series may not warrant widespread public acceptance for recurrent COVID-19 vaccination doses. In addressing booster vaccine hesitancy as restrictive measures and mandates are lifted, health perceptions relevant or unique to booster vaccine uptake should be considered.

The Preferences for Attributes of Initial COVID-19 Diagnosis in the US and China during the Pandemic: A Discrete Choice Experiment with Propensity Score Matching

Background

China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights.

Objective

We aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States.

Methods

We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test.

Results

A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred.

Conclusions

Improvements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance.

Influence factors analysis of COVID-19 Prevention behavior of chinese Citizens: a path analysis based on the hypothetical model

BACKGROUND

Under the outbreak of Coronavirus disease 2019 (COVID-19), a structural equation model was established to determine the causality of important factors that affect Chinese citizens' COVID-19 prevention behavior.

METHODS

The survey in Qingdao covered several communities in 10 districts and used the method of cluster random sampling. The research instrument used in this study is a self-compiled Chinese version of the questionnaire. Of the 1215 questionnaires, 1188 were included in our analysis. We use the rank sum test, which is a non-parametric test, to test the influence of citizens'basic sociodemographic variables on prevention behavior, and the rank correlation test to analyze the influencing factors of prevention behavior. IBM AMOS 24.0 was used for path analysis, including estimating regression coefficients and evaluating the statistical fits of the structural model, to further explore the causal relationships between variables.

RESULTS

The result showed that the score in the prevention behavior of all citizens is a median of 5 and a quartile spacing of 0.31. The final structural equation model showed that the external support for fighting the epidemic, the demand level of health information, the cognition of (COVID-19) and the negative emotions after the outbreak had direct effects on the COVID-19 prevention behavior, and that negative emotions and information needs served as mediating variables.

CONCLUSIONS

The study provided a basis for relevant departments to further adopt epidemic prevention and control strategies.

Acceptance of and Preference for COVID-19 Vaccination in India, the United Kingdom, Germany, Italy, and Spain: An International Cross-Sectional Study

Objective: India and Europe have large populations, a large number of Coronavirus disease 2019 (COVID-19) cases, and different healthcare systems. This study aims to investigate the differences between the hesitancy toward and preference for COVID-19 vaccines in India and four European countries, namely, the United Kingdom (UK), Germany, Italy, and Spain. Methodology: We conducted a cross-national survey for distribution in India, the UK, Germany, Italy, and Spain. More specifically, a discrete choice experiment (DCE) was conducted to evaluate vaccine preferences, and Likert scales were used to probe the underlying factors that contribute to vaccination acceptance. Propensity score matching (PSM) was performed to directly compare India and European countries. Results: A total of 2565 respondents (835 from India and 1730 from the specified countries in Europe) participated in the survey. After PSM, more than 82.5% of respondents from India positively accepted the COVID-19 vaccination, whereas 79.9% of respondents from Europe had a positive attitude; however, the proportion in Europe changed to 81.6% in cases in which the vaccine was recommended by friends, family, or employers. The DCE found that the COVID-19 vaccine efficacy was the most important factor for respondents in India and the four European nations (41.8% in India and 47.77% in Europe), followed by the vaccine cost (28.06% in India and 25.88% in Europe). Conclusion: Although most respondents in both regions showed high acceptance of COVID-19 vaccines, either due to general acceptance or acceptance as a result of social cues, the vaccination coverage rate shows apparent distinctions. Due to the differences in COVID-19 situations, public health systems, cultural backgrounds, and vaccine availability, the strategies for COVID-19 vaccine promotion should be nation-dependent.

Self-Reported COVID-19 Vaccine Hesitancy and Willingness to Pay: A Cross-Sectional Survey in Thailand

This study aimed to estimate the prevalence and influencing factors of COVID-19 vaccine hesitancy and willingness to pay in Thailand. A descriptive cross-sectional study was conducted from 13 September 2021 to 14 January 2022. Data were collected using an online questionnaire consisting of demographic characteristics, COVID-19 vaccine hesitancy (delay in acceptance and denying vaccination), determinants of vaccine hesitancy (complacency, convenience, and confidence), and willingness to pay. The general Thai population aged ≥18 years were surveyed. Among 705 respondents, 10.4% reported hesitancy, with significant determinants being low complacency and confidence in the vaccine; low convenience was not a significant determinant. Multivariate analysis revealed vaccine hesitancy among women, those with higher education, non-healthcare workers, and those who lived in rural areas. Furthermore, 77.2% of respondents were willing to pay, with the majority willing to pay in the range of THB 501-1000 ( USD 1 = THB 33) per dose. Increased monthly income, no impact of COVID-19 on income, and time period (before mRNA vaccine availability) significantly affected willingness to pay.

Personality Effects on Chinese Public Preference for the COVID-19 Vaccination: Discrete Choice Experiment and Latent Profile Analysis Study

Objective: This study aims to investigate the differences in public vaccination preference for the COVID-19 vaccine with different personality characteristics. Methods: Based on the Big Five Personality Inventory (BFI-10), a total of 1200 respondents were categorized by personality characteristics using Latent Profile Analysis (LPA). The preference of members the public with different personality characteristics for COVID-19 vaccination was investigated based on a discrete choice experiment (DCE). Results: All respondents were divided into three groups, named the General and Stable type (79.67%), Conscientious and Agreeable type (9.5%), and Open and Extroverted type (10.83%). For the percentage importance of vaccine attributes, both the General and Stable type and Conscientious and Agreeable type respondents considered cost to be the most important (41.93% and 34.95% respectively). However, the Open and Extroverted type respondents considered efficacy as the most important (31.05%). In our conditional logit model (CLOGIT), for vaccine adverse effects, the General and Stable type and Conscientious and Agreeable type respondents preferred “very mild”, while the Open and Extroverted type preferred “mild” (OR:1.108, 95%CI 0.977–1.256). The Open and Extroverted type had a higher willingness to pay (WTP) for the most preferred vaccine level compared to the other types. Conclusions: The Open and Extroverted respondents have the highest willingness to vaccinate. The General and Stable type and Conscientious and Agreeable respondents think that the cost of the vaccine is the most important attribute, and prefer the mildest side effects. The Open and Extroverted type think that vaccine efficacy is the most important attribute, prefer “mild” side effects, and have higher willingness to pay for their favorite vaccine level.

The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019

Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a “good” (47.5%) or “sufficient” (20.1%) level of VL, 32.4% had “limited” VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities.

Vaccine Hesitancy Under the Magnifying Glass: A Systematic Review of the Uses and Misuses of an Increasingly Popular Construct

Resistance to vaccines has hindered attempts to contain and prevent outbreaks of infectious diseases for centuries. More recently, however, the term "vaccine hesitancy" has been used to describe not necessarily outright resistance but also a delay in acceptance or uncertainty regarding vaccines. Given concerns about hesitancy and its impact on vaccine uptake rates, researchers increasingly shifted the focus from resistance to vaccines toward vaccine hesitancy. Acknowledging the urgency to accurately assess the phenomenon, it is critical to understand the state of the literature, focusing on issues of conceptualization and operationalization. To carry out this systematic review, we collected and analyzed all published empirical articles from 2000 to 2021 that explicitly included quantitative self-report measures of vaccine hesitancy (k = 86). Using a mixed-method approach, the review demonstrates and quantifies crucial inconsistencies in the measurement of the construct, lack of clarity in regard to the determination of who should or should not be defined as hesitant, and overreliance on unrepresentative samples. Crucially, our analysis points to a potential systematic bias toward exaggerating the level of hesitancy in the population. Modeling a vaccine hesitancy co-citation network, the analysis also points to the existence of insular academic silos that make it harder to achieve a unified measurement tool. Theoretical and practical implications for academics, practitioners, and policymakers are discussed.

Individual Preferences for COVID-19 Vaccination under the China’s 2021 National Vaccination Policy: A Discrete Choice Experiment Study

(1) Background: Since China’s national vaccination policy announcement in January 2021, individual vaccination preferences related to vaccine characteristics, social relationships, sociodemographic characteristics and cognition remain opaque. This study aims to investigate vaccination preferences regarding these attributes, and to assess changes in individual vaccine preferences since the pre-2021 emergency vaccination phase. (2) Methods: The two-part questionnaire surveyed 849 individuals between May and June 2021 in Qingdao, China. The survey contained eight binary choice tasks that investigated preference trade-offs. Respondents’ sociodemographic characteristics, including age, sex, urban/rural residence, income, education and whether living with the young or old, were also collected. Conditional logit, mixed logit and latent class models were used to quantify preference utility and identify preference heterogeneity. (3) Results: Vaccine effectiveness, vaccine side effects, duration of protection and probability of infection all significantly affected vaccination utility. Preference heterogeneity based on individual social relationships and sociodemographic characteristics were also established. Marginal analysis showed that compared to the pre-2021 phase, individuals’ preferences had shifted towards vaccines with longer protection periods and better accessibility. (4) Conclusion: This study will inform the full rollout of China’s 2021 national vaccination program and provide valuable information for future vaccination policy design to meet resurgent COVID-19 risks.

Improving Risk Management by Learning from Adverse Events: Report on One Year of COVID-19 Vaccination Campaign in Verona (Northeastern Italy)

Background: The COVID-19 mass vaccination campaign posed new challenges not only from a healthcare perspective, but also in terms of distribution, logistics, and organization. Managing clinical risk in off-site vaccination centers during a pandemic provided a new opportunity for the training and acquisition of competencies through continuous learning from adverse events. The aim of this report, based on a review of activity, was to identify the most recurrent and high-risk failures of the vaccination process in a mass vaccination center. Methods: Adverse events and near misses reported during the first 11 months of activity (February 2021–January 2022) in the mass vaccination center of Verona (Italy) were evaluated. Results: From 15 February 2021 to 17 January 2022 the center administered about 460,000 doses to the population and nine adverse events and one near miss were reported. Most of the events were errors in vaccine administration, either in principle, dosage, or timing with respect to the indicated schedule. All events had minor outcomes. Communication errors, inadequate training, and general organizational issues were the most recurrent factors contributing to the events. Conclusions: Risk mitigation during mass vaccination in temporary sites is an essential element of a successful vaccination campaign. The reporting of adverse events should be encouraged in order to obtain as much information as possible for a continuous improvement of the activity.

Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for the translation and validation in the WHO EMRO region

Background

The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French.

Objective

The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region.

Methods

The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants’ responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected.

Results

As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022.

Conclusions

This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation.

International Registered Report Identifier (IRRID)

PRR1-10.2196/36928

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.

Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance

INTRODUCTION

Vaccination is an essential intervention to curb the coronavirus disease 2019 (COVID-19) pandemic. This review aimed to estimate the pooled proportion of COVID-19 vaccine acceptance worldwide.

METHODS

A systematic search of the MEDLINE (PubMed) database using "COVID-19," "vaccine" and "acceptance" to obtain original research articles published between 2020 and July 2021. Only studies with full text and that were published in English were included. The Joanna Briggs Institute meta-analysis was used to assess the data quality. The meta-analysis was performed using generic inverse variance with a random-effects model using the Review Manager software.

RESULTS

A total of 172 studies across 50 countries worldwide were included. Subgroup analyses were performed with regard to vaccine acceptance, regions, population, gender, vaccine effectiveness, and survey time. The pooled proportion of COVID-19 vaccine acceptance was 61% (95% CI: 59, 64). It was higher in Southeast Asia, among healthcare workers, in males, for vaccines with 95% effectiveness, and during the first survey.

CONCLUSION

COVID-19 vaccine acceptance needs to be increased to achieve herd immunity to protect the population from the disease. It is crucial to enhance public awareness of COVID-19 vaccination and improve access to vaccines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2021, identifier CRD42021268645.

A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Weakening personal protective behavior by Chinese university students after COVID-19 vaccination

Personal protective behaviors and their dynamic change are known to play a major role in the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal pathogen of the coronavirus disease 2019 (COVID-19) pandemic. In this study, a total of 3229 students in Chinese universities completed an online survey about their knowledge on transmission and personal protective behavior before and after COVID-19 vaccination. Of the respondents, 87.6% had been vaccinated. Most students believed that the large droplet (97.0%) and short-range airborne (89.3%) routes were the two most likely SARS-CoV-2 transmission routes, whereas only 24.1% considered long-range airborne transmission to be possible. Students who would be expected to possess better knowledge about virus transmission (e.g., students of medicine) reported better personal protective behaviors. Female students reported relatively better personal hygiene practices than male students, so did the confident students than their diffident peers. Students washed their hands on average of 5.76 times per day during the pandemic. Students at universities in southern regions washed their hands more frequently but paid less attention to indoor ventilation than did their northern counterparts. Interestingly, students who are fear of being infected had the bad personal hygiene. University students wore 22% less masks in public indoor environments after vaccination. Chinese university students weakened their personal protective behavior after vaccination and it may increase the potential risk of infection in the new waves of variant virus (e.g. delta).

COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

Recommending COVID-19 Vaccines to Patients: Practice and Concerns of Frontline Family Doctors

Background: Recommendation from doctors is a well-recognized motivator toward vaccine uptake. Family doctors are in the prime position to advise the public on COVID-19 vaccination. We studied the practice and concerns of frontline family doctors concerning COVID-19 vaccination recommendations to patients. Methods: We conducted a cross-sectional online survey of all family doctors in the Hong Kong College of Family Physicians between June and July 2021. Their practice of making COVID-19 recommendation to patients was assessed. Based on the Health Belief Model, factors associated with doctors' recommendation practices were explored and examined. Multivariate logistic regression models were used to investigate the factors, including COVID-19 vaccine attributes, associated with doctors' practices in making recommendations. Their own vaccination status and psychological antecedents to vaccine hesitancy were measured. Results: A total of 312 family doctors responded (a 17.6% response rate). The proportion of doctors who had received COVID-19 vaccines was 90.1%. The proportion of doctors who would recommend all patients without contraindications for the vaccination was 64.4%. The proportion of doctors who would proactively discuss COVID-19 vaccines with patients was 52.9%. Multivariate logistic regression analysis showed that doctors' own COVID-19 vaccination status was the strongest predictor of family doctors making a recommendation to patients (aOR 12.23 95% CI 3.45-43.33). Longer duration of practice, willingness to initiate the relevant discussion with patients and less worry about vaccine side effects on chronic illness patients were the other factors associated with making a COVID-19 vaccination recommendation. Conclusions: Family doctors should be encouraged to get vaccinated themselves and initiate discussions with patients about COVID-19 vaccines. Vaccine safety data on patients with chronic illness, training and guidelines for junior doctors may facilitate the COVID-19 vaccination recommendation practices of family doctors.

Association between Immunoglobulin G Levels and Adverse Effects Following Vaccination with the BNT162b2 Vaccine among Japanese Healthcare Workers

The purpose of the study was to assess the association between the amount of immunoglobulin G (IgG) and the duration of adverse effects of COVID-19 vaccinations in the Japanese population. This cross-sectional study was conducted from April 2020 to August 2021 among workers at a community hospital. All participants received two doses of the BNT162b2 vaccine (Pfizer-BioNTech) in March and April 2021. Vaccine side effects were measured using a self-administered questionnaire. Serum anti-SARS-CoV-2 IgG was measured 3 months after vaccination. There was a total of 338 participants (mean age: 44.7 years). The incidence of adverse reactions after vaccination was higher in women. Adverse reactions associated with higher IgG levels included: erythema at the injection site after the first dose; induration and inflammation at the injection site; and systemic symptoms, e.g., fever and headache after the second dose. IgG levels were higher in younger participants. These findings could mitigate fears regarding the mild adverse effects of the COVID-19 vaccine and encourage uptake of the BNT162b2 vaccine.

COVID-19 risk of infection and vaccination during Ramadan fasting: knowledge and attitudes of Bangladeshi general population

There is some debate whether COVID-19 infection and vaccination will hamper Ramadan among the Muslim population worldwide. Therefore, this study aimed to assess the total proportion of the Bangladeshi population who has adequate knowledge and attitude towards COVID-19 risk of infections and vaccination during Ramadan fasting. A cross-sectional study had conducted among 502 adult participants of Bangladesh. We have used a structured questionnaire which had implemented through a face-to-face interview by trained data collectors. Data were analyzed using statistical package software SPSS version 25.0. Of the 502 participants, 50.2% were male, and most (49.6%) lived in urban areas. About 72.5% and 76.30% reported having adequate knowledge and a positive attitude, respectively, regarding COVID-19 risk of infection and vaccination during Ramadan fasting. Among all variables, no formal education and up to class 8 education had significantly associated with inadequate knowledge (OR = 5.14, 95% CI = 1.63-16.19, and OR = 6.42, 95% CI = 2.55-16.19). Educational status was also associated with attitude (OR = 3.68, 95%CI = 1.17-11.55). Current smokers reported a negative attitude in comparison to non-smokers (OR = 2.48, 95% CI = 1.36-4.50). In conclusion, our study found overall moderate knowledge and attitude among the Bangladeshi population towards COVID-19 infection and vaccination. Government should continue its efforts to increase the knowledge and attitude level to a higher level, and anti-smoking campaigns should strengthen to make people stop smoking to reduce the COVID-19 severity.

Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy

Purposes: To explore the associated factors of COVID-19 vaccine hesitancy and examine psychometric properties of the coronavirus-related health literacy questionnaire (HLS-COVID-Q22) and Oxford COVID-19 Vaccine Hesitancy questionnaire. Methods: An online survey was conducted from 23 June to 16 July 2021 on 387 school principals across Taiwan. Data collection included socio-demographic characteristics, information related to work, physical and mental health, COVID-19 related perceptions, sense of coherence, coronavirus-related health literacy, and vaccine hesitancy. Principal component analysis, correlation analysis, linear regression models were used for validating HLS-COVID-Q22, Oxford COVID-19 Vaccine Hesitancy, and examining the associations. Results: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were found with satisfactory construct validity (items loaded on one component with factor loading values range 0.57 to 0.81, and 0.51 to 0.78), satisfactory convergent validity (item-scale correlations range 0.60 to 0.79, and 0.65 to 0.74), high internal consistency (Cronbach’s alpha = 0.96 and 0.90), and without floor or ceiling effects (percentages of possibly lowest score and highest score <15%), respectively. Low scores of vaccine hesitancy were found in male principals (regression coefficient, B, −0.69; 95% confidence interval, 95%CI, −1.29, −0.10; p = 0.023), principals with better well-being (B, −0.25; 95%CI, −0.47, −0.03; p = 0.029), and higher HLS-COVID-Q22 (B, −1.22; 95%CI, −1.89, −0.54; p < 0.001). Conclusions: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were valid and reliable tools. Male principals and those with better well-being, and higher health literacy had a lower level of vaccine hesitancy. Improving principals’ health literacy and well-being is suggested to be a strategic approach to increase vaccine acceptance for themselves, their staff, and students.