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Murali A, Sojati J, Levochkina M, Pressimone C, Griffith K, Fan E, Dakroub A. A Cross-Sectional Analysis of Community Perceptions of Flu and COVID-19 Vaccines at Turtle Creek Primary Care Center. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:439-451. [PMID: 37837451 DOI: 10.1177/2752535x231205665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature. OBJECTIVE The objective of this mixed-methods study was to elucidate attitudes of patients at the Turtle Creek Primary Care Center, a clinic that cares for ∼70% non-white patients, towards flu and COVID-19 vaccines, with the goal of establishing vaccine education gaps and increasing vaccine uptake in minority communities. DESIGN/PATIENTS This study was conducted as a cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek clinic inquiring about flu and COVID-19 infection status and vaccination uptake (August 26-October 10, 2021). APPROACH/KEY RESULTS We found that rates of vaccination were subpar in the Turtle Creek community, with only 54% having received the COVID-19 vaccine and only 44% receiving the flu vaccine regularly. There was a strong association between COVID-19 and flu vaccine acceptance and a notable correlation between vaccine acceptance and age. When assessing how vaccine acceptance was influenced by trusted sources of information, those who cited trusting "medical professionals" and "word of mouth" had higher odds of COVID-19 vaccine acceptance but those who cited trusting "social media" had decreased odds of acceptance. Finally, we uncovered 14 common factors for either vaccine acceptance or refusal that clustered into four overarching themes of trust, need, safety, and availability. CONCLUSION These data highlight the necessity of improved vaccine education and reveal targetable populations and approaches for disseminating vaccine information.
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Affiliation(s)
- Anjana Murali
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jorna Sojati
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marina Levochkina
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kobi Griffith
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Fan
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allie Dakroub
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Guo X, Han Q, Wang Y, Zhang R, Huang Y, Guo B. Influenza Vaccine Hesitancy among Cancer Survivors in China: A Multicenter Survey. Vaccines (Basel) 2024; 12:639. [PMID: 38932368 PMCID: PMC11209103 DOI: 10.3390/vaccines12060639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Cancer survivors are at higher risk of developing severe complications from influenza due to their compromised immune systems. Despite their increased vulnerability to influenza and the availability of vaccines, vaccine hesitancy among cancer survivors remains a significant public health concern in China. METHODS A multicenter, cross-sectional study was conducted among cancer survivors in China from January to December 2023. A total of 500 participants were recruited from the oncology departments of five tertiary hospitals. A structured, self-administered questionnaire was used to collect data on socio-demographic characteristics, cancer-related information, medical history, lifestyle factors, and influenza vaccine hesitancy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with influenza vaccine hesitancy. RESULTS The response rate was 97.0% (485/500). Among all participants, 204 (42.06%) reported vaccine hesitancy. The results of multiple logistic regression showed that the longer the end of anti-cancer treatment, without a history of adverse vaccine reactions, and the level of family support played a protective role in vaccine hesitancy. Current rehabilitation status, frequent colds, not being informed by doctors about vaccination, exercising, lack of community vaccination education programs, and concerns about vaccine safety were risk factors that increase vaccine hesitancy. CONCLUSIONS A high proportion of cancer survivors in our study reported influenza vaccine hesitancy. Addressing concerns about vaccine safety, improving access to vaccination services, and enhancing doctor-patient communication are crucial for increasing influenza vaccine uptake in this vulnerable population.
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Affiliation(s)
- Xin Guo
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Qi Han
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuqin Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Rui Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuenan Huang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Botang Guo
- Department of Medical Psychology, Harbin Medical University, Baojian Road 158, Harbin 150078, China
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen 518001, China
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Barwise A, Tekin A, Domecq Garces JP, Gajic O, Pickering BW, Malinchoc M. Impact of SARS-CoV-2 Vaccine Rollout on Hispanic and Non-Hispanic Admission and Mortality Trends: An Interrupted Time Series Analysis. Chest 2024; 165:1341-1351. [PMID: 38145716 DOI: 10.1016/j.chest.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Challenges with SARS-CoV-2 vaccine prioritization, access, and hesitancy have influenced vaccination uptake. RESEARCH QUESTION Was the impact of SARS-CoV-2 vaccine rollout on COVID-19 monthly admission and mortality trends different between Hispanic and non-Hispanic populations? STUDY DESIGN AND METHODS We used interrupted time series analysis to conduct an ancillary study of the Viral Infection and Respiratory Illness Universal Study registry supplemented by electronic health record data from five participating Mayo Clinic sites in Florida, Arizona, Minnesota, and Wisconsin. We included hospitalized patients with COVID-19 admitted between April 2020 and December 2021. Our primary outcome was the impact of vaccine rollout on admission trends. Our secondary outcome was the impact of vaccine rollout on mortality trends. RESULTS This interrupted time series analysis includes 6,442 patients. Vaccine rollout was associated with improved monthly hospital admission trends among both Hispanic and non-Hispanic patients. Among Hispanic patients, pre-vaccine rollout, monthly admissions increased by 12.9% (95% CI, 8.1%-17.9%). Immediately after vaccine rollout, patient admissions declined by -66.3% (95% CI, -75.6% to -53.9%). Post-vaccine rollout, monthly admissions increased by 3.7% (95% CI, 0.2%-7.3%). Among non-Hispanic patients, pre-vaccine rollout, monthly admissions increased by 35.8% (95% CI, 33.4%-38.1%). Immediately after vaccine rollout, patient admissions declined by -75.2% (95% CI, -77.6% to -72.7%). Post-vaccine rollout, monthly admissions increased by 5.6% (95% CI, 4.5%-6.7%). These pre-vaccine rollout admission trends were significantly different (P < .001). Post-vaccine rollout, the change in admission trend was significantly different (P < .001). The associated beneficial impact from vaccine rollout on monthly hospital admission trends among Hispanic patients was significantly lower. The trend in monthly mortality rate was fourfold greater (worse) among Hispanic patients (8.3%; 95% CI, 3.6%-13.4%) vs non-Hispanic patients (2.2%; 95% CI, 0.6%-3.8%), but this was not shown to be related to vaccine rollout. INTERPRETATION SARS-CoV-2 vaccine rollout was associated with improved COVID-19 admission trends among non-Hispanic vs Hispanic patients. Vaccine rollout was not shown to influence mortality trends in either group, which were four times higher among Hispanic patients. Improved vaccine rollout may have reduced disparities in admission trends for Hispanic patients, but other factors influenced their mortality trends.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Rochester, MN; Bioethics Research Program, Rochester, MN.
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Rochester, MN
| | | | | | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Rochester, MN
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Manoharan B, Stennett R, de Souza RJ, Bangdiwala SI, Desai D, Kandasamy S, Khan F, Khan Z, Lear SA, Loh L, Nocos R, Schulze KM, Wahi G, Anand SS. Sociodemographic factors associated with vaccine hesitancy in the South Asian community in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00885-7. [PMID: 38713364 DOI: 10.17269/s41997-024-00885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/21/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE South Asians represent the largest non-white ethnic group in Canada and were disproportionately impacted by the COVID-19 pandemic. We sought to determine the factors associated with vaccine hesitancy in South Asian Canadians. METHODS We conducted a cross-sectional analysis of vaccine hesitancy using data collected at the baseline assessment of a prospective cohort study, COVID CommUNITY South Asian. Participants (18 + years) were recruited from the Greater Toronto and Hamilton Area in Ontario (ON) and the Greater Vancouver Area in British Columbia (BC) between April and November 2021. Demographic characteristics and vaccine attitudes measured by the Vaccine Attitudes Examination (VAX) scale were collected. Each item is scored on a 6-point Likert scale, and higher scores reflect greater hesitancy. A multivariable linear mixed effects model was used to identify sociodemographic factors associated with vaccine hesitancy, adjusting for multiple covariates. RESULTS A total of 1496 self-identified South Asians (52% female) were analyzed (mean age = 38.5 years; standard deviation (SD): 15.3). The mean VAX score was 3.2, SD: 0.8 [range: 1.0‒6.0]. Factors associated with vaccine hesitancy included: time since immigration (p = 0.04), previous COVID-19 infection (p < 0.001), marital status (p < 0.001), living in a multigenerational household (p = 0.03), age (p = 0.02), education (p < 0.001), and employment status (p = 0.001). CONCLUSION Among South Asians living in ON and BC, time since immigration, prior COVID-19 infection, marital status, living in a multigenerational household, age, education, and employment status were associated with vaccine hesitancy. This information can be used to address vaccine hesitancy in the South Asian population in future COVID-19 waves or pandemics.
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Affiliation(s)
- Baanu Manoharan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Farah Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Zainab Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lawrence Loh
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rochelle Nocos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Karleen M Schulze
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Population Health Research Institute, Hamilton, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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Sentamilvannan M, Al-Dekany A, Eide HN, Lie AK. [Vaccine hesitancy during the COVID-19 pandemic among young people with an ethnic background in east Oslo – a qualitative study]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2024; 144:23-0690. [PMID: 38651718 DOI: 10.4045/tidsskr.23.0690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background Few studies have been conducted on young people's attitudes to the COVID-19 vaccine during the pandemic. We wished to examine how young people with an ethnic minority background decided whether to have the COVID-19 vaccine, based on the concept of vaccine hesitancy. Vaccine hesitancy involves uncertainty with regard to vaccination, irrespective of the decision taken. Material and method Fourteen qualitative in-depth interviews with young people aged 16-25 years with an ethnic minority background and from the east side of Oslo were analysed and categorised into main themes. The participants also had links to the Middle East, South Asia and Africa. Results Several of the study participants were hesitant to be vaccinated. Their hesitation was linked to the impression that the vaccine had been developed rapidly, false rumours, long travel times to vaccination centres and fear of adverse effects. A number called for better information. Vaccination through the school was described as a facilitating factor. Family and friends were less crucial in their assessment of whether to have the COVID-19 vaccine. The majority had trust in the authorities. Interpretation Insufficient knowledge about the vaccine and fear of adverse effects, as well as practical barriers associated with undergoing vaccination, appears to contribute to vaccine scepticism among young people with an ethnic minority background. The authorities and healthcare personnel should provide young people with better vaccine information. Information should be provided by personnel they already trust, such as the school nurse.
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Affiliation(s)
| | | | | | - Anne Kveim Lie
- Avdeling for samfunnsmedisin og global helse, Universitetet i Oslo
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Cénat JM, Moshirian Farahi SMM, Broussard C, Dalexis RD. The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination. Vaccine 2024; 42:960-968. [PMID: 37891050 DOI: 10.1016/j.vaccine.2023.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Black communities in Canada have been among the most affected by the COVID-19 pandemic, in terms of number of infections and deaths. They are also among those most hesitant about vaccination against COVID-19. However, while a few studies have documented the factors associated with COVID-19 vaccine hesitancy, those related to vaccine confidence remain unknown. To respond to this gap, this study aims to investigate factors associated to vaccine confidence in Black individuals in Canada. METHODS A total of 2002 participants (1034 women) aged 14 to 89 years old (Mean age = 29.34, SD = 10.13) completed questionnaires assessing sociodemographic information, COVID-19 vaccine confidence and need, health literacy, conspiracy beliefs, major racial discrimination, and traumatic stressors related to COVID-19. RESULTS Results showed an average score of COVID-19 vaccine confidence and need of 33.27 (SD = 7.24), with no significant difference between men (33.48; SD = 7.24) and women (33.08; SD = 7.91), t (1999) = 1.19, p = 0.234. However, there were significant differences according to employment status, migration status, age, inhabited province, spoken language, education, marital status, religion, and income. The linear regression model explained 25.8 % of the variance and showed that health literacy (B = 0.12, p < 0.001) and traumatic stressors related to COVID-19 (B = 0.21, p < .001) predicted COVID-19 vaccine confidence and need positively, while conspiracy beliefs (B = -1.14, p < 0.001) and major racial discrimination (B = -0.20, p = 0.044) predicted it negatively. CONCLUSIONS This study showed that building the confidence of Black communities in vaccines requires health education, elimination of racial discrimination in the Canadian society and a focus on certain groups (e.g., young people, those living in Quebec and Ontario). The results also argue in favor of involving community leaders and organizations in the development and implementation of vaccination-related tools, strategies and programs by city, provincial and federal public health agencies.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | | | - Cathy Broussard
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Ferroni E, Gennaro N, Maifredi G, Leoni O, Profili F, Stasi C, Cacciani L, Calandrini E, di Napoli A, Petrelli A, Zorzi M. Access to SARS-CoV-2 vaccination in immigrants in Italy, by geographical area of origin. Vaccine 2024; 42:375-382. [PMID: 38097455 DOI: 10.1016/j.vaccine.2023.11.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 01/01/2024]
Abstract
OBJECTIVE Immigrants are commonly considered disadvantaged and at high risk of not receiving appropriate care, including vaccination. This study aimed to evaluate the access to SARS-CoV-2 vaccination in immigrants, by geographical area of origin, compared with Italian citizens. We also evaluated sex differences in vaccine's coverage by geographical area of origin. METHODS We performed a retrospective observational study in four Italian regions, including all resident subjects aged 5-69 years, and undergoing first dose SARS-CoV-2 vaccination in the period 28th December 2020- 3rd April 2022. We estimated cumulative coverage percentages, by age class and geographical area. To compare first-dose vaccine coverage by geographical area of origin, we estimated, through a Poisson analysis, Vaccine Coverage Ratios (VCR) with 95 % confidence intervals (95 %CI), adjusting for age and sex. RESULTS We included 16,294,785 Italian citizens and 2,534,351 immigrants aged 5-69 years and resident in the four regions considered. Regarding the geographical area of origin, 40.7 % of immigrants came from Eastern Europe, 13.5 % from North Africa and 13.1 % from Western Asia. A great variability in the first dose vaccine coverage emerged. We documented substantial heterogeneity in the first-dose vaccine coverage within immigrant's population, expressed with Italy as a reference, ranging from 0,768 (95 %CI: 0,766-0,769) in Eastern Europe countries to 1,013 (95 %CI: 1,009 - 1,018) in Eastern Asia. The chance of being vaccinated was found higher in males compared with females for African countries (VCR 1.07, 95 %CI 1.06-1.08) and Western Asian countries (VCR 1.08, 95 %CI 1.07-1.09). CONCLUSION We observed substantial heterogeneity in first-dose SARS-CoV-2 vaccination coverage in immigrants, suggesting a different propensity to vaccines according to the geographical area of origin. These data can help define appropriate and tailored strategies in order to improve vaccine coverage in some specific immigrant groups at the local health district level.
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Affiliation(s)
- Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy
| | | | - Olivia Leoni
- Directorate General for Health, Lombardy Region, Milan, Italy
| | | | - Cristina Stasi
- Epidemiology Unit, Tuscany Regional Health Agency, Florence, Italy
| | - Laura Cacciani
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Enrico Calandrini
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Anteo di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Manuel Zorzi
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy
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Saravanan V, Chagaleti BK, Narayanan PL, Anandan VB, Manoharan H, Anjana GV, Peraman R, Namasivayam SKR, Kavisri M, Arockiaraj J, Muthu Kumaradoss K, Moovendhan M. Discovery and development of COVID-19 vaccine from laboratory to clinic. Chem Biol Drug Des 2024; 103:e14383. [PMID: 37953736 DOI: 10.1111/cbdd.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
The world has recently experienced one of the biggest and most severe public health disasters with severe acute respiratory syndrome coronavirus (SARS-CoV-2). SARS-CoV-2 is responsible for the coronavirus disease of 2019 (COVID-19) which is one of the most widespread and powerful infections affecting human lungs. Current figures show that the epidemic had reached 216 nations, where it had killed about 6,438,926 individuals and infected 590,405,710. WHO proclaimed the outbreak of the Ebola virus disease (EVD), in 2014 that killed hundreds of people in West Africa. The development of vaccines for SARS-CoV-2 becomes more difficult due to the viral mutation in its non-structural proteins (NSPs) especially NSP2 and NSP3, S protein, and RNA-dependent RNA polymerase (RdRp). Continuous monitoring of SARS-CoV-2, dynamics of the genomic sequence, and spike protein mutations are very important for the successful development of vaccines with good efficacy. Hence, the vaccine development for SARS-CoV-2 faces specific challenges starting from viral mutation. The requirement of long-term immunity development, safety, efficacy, stability, vaccine allocation, distribution, and finally, its cost is discussed in detail. Currently, 169 vaccines are in the clinical development stage, while 198 vaccines are in the preclinical development stage. The majority of these vaccines belong to the Ps-Protein subunit type which has 54, and the minor BacAg-SPV (Bacterial antigen-spore expression vector) type, at least 1 vaccination. The use of computational methods and models for vaccine development has revolutionized the traditional methods of vaccine development. Further, this updated review highlights the upcoming vaccine development strategies in response to the current pandemic and post-pandemic era, in the field of vaccine development.
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Affiliation(s)
- Venkatesan Saravanan
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Bharath Kumar Chagaleti
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Pavithra Lakshmi Narayanan
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Vijay Babu Anandan
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Haritha Manoharan
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - G V Anjana
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Ramalingam Peraman
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Hajipur, India
| | - S Karthik Raja Namasivayam
- Department of Research & Innovation, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - M Kavisri
- Department of Civil Engineering, Saveetha School of Engineering, SIMATS Deemed University, Chennai, India
| | - Jesu Arockiaraj
- Department of Biotechnology, Faculty of Science and Humanities, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Kathiravan Muthu Kumaradoss
- Dr. APJ Abdul Kalam Research Lab, SRM College of Pharmacy, SRM Institute of Science and Technology, Chengalpattu District, India
| | - Meivelu Moovendhan
- Centre for Ocean Research, Col. Dr. Jeppiar Research Park, Sathyabama Institute of Science and Technology, Chennai, India
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Towett G, Snead RS, Grigoryan K, Marczika J. Geographical and practical challenges in the implementation of digital health passports for cross-border COVID-19 pandemic management: a narrative review and framework for solutions. Global Health 2023; 19:98. [PMID: 38066568 PMCID: PMC10709942 DOI: 10.1186/s12992-023-00998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rapid global spread of infectious diseases, epitomized by the recent COVID-19 pandemic, has highlighted the critical need for effective cross-border pandemic management strategies. Digital health passports (DHPs), which securely store and facilitate the sharing of critical health information, including vaccination records and test results, have emerged as a promising solution to enable safe travel and access to essential services and economic activities during pandemics. However, the implementation of DHPs faces several significant challenges, both related to geographical disparities and practical considerations, necessitating a comprehensive approach for successful global adoption. In this narrative review article, we identify and elaborate on the critical geographical and practical barriers that hinder global adoption and the effective utilization of DHPs. Geographical barriers are complex, encompassing disparities in vaccine access, regulatory inconsistencies, differences across countries in data security and users' privacy policies, challenges related to interoperability and standardization, and inadequacies in technological infrastructure and limited access to digital technologies. Practical challenges include the possibility of vaccine contraindications and breakthrough infections, uncertainties surrounding natural immunity, and limitations of standard tests in assessing infection risk. To address geographical disparities and enhance the functionality and interoperability of DHPs, we propose a framework that emphasizes international collaboration to achieve equitable access to vaccines and testing resources. Furthermore, we recommend international cooperation to establish unified vaccine regulatory frameworks, adopting globally accepted standards for data privacy and protection, implementing interoperability protocols, and taking steps to bridge the digital divide. Addressing practical challenges requires a meticulous approach to assessing individual risk and augmenting DHP implementation with rigorous health screenings and personal infection prevention measures. Collectively, these initiatives contribute to the development of robust and inclusive cross-border pandemic management strategies, ultimately promoting a safer and more interconnected global community in the face of current and future pandemics.
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Giwa A, Adeagbo M, Tate SA, Tulli-Shah M, Salami B. COVID-19 Vaccine Mandates and Vaccine Hesitancy among Black People in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7119. [PMID: 38063549 PMCID: PMC10706298 DOI: 10.3390/ijerph20237119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES COVID-19 vaccine mandates increased vaccination rates globally. Implemented as a one-size-fits-all policy, these mandates have unintended harmful consequences for many, including Black Canadians. This article reports findings on the interconnectedness of vaccine mandates and vaccine hesitancy by describing a range of responses to mandatory COVID-19 vaccination policies among Black people in Canada. METHODS Using qualitative research methods, semi-structured interviews with 36 Black people living in Canada aged 18 years and over across 6 provinces in Canada were conducted. Participants were selected across intersectional categories including migration status, income, religion, education, sex, and Black ethnicity. Thematic analysis informed the identification of key themes using Foucauldian notions of biopower and governmentality. RESULTS Our results show how the power relations present in the ways many Black people actualize vaccine intentions. Two main themes were identified: acceptance of the COVID-19 vaccine in the context of governmentality and resistance to vaccine mandates driven by oppression, mistrust, and religion. CONCLUSION COVID-19 vaccine mandates may have reinforced mistrust of the government and decreased confidence in the COVID-19 vaccine. Policy makers need to consider non-discriminatory public health policies and monitor how these policies are implemented over time and across multiple sectors to better understand vaccine hesitancy.
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Affiliation(s)
- Aisha Giwa
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Morolake Adeagbo
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Shirley Anne Tate
- Department of Sociology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Mia Tulli-Shah
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
| | - Bukola Salami
- College of Health Sciences, School of Public Health University of Alberta, Edmonton, AB T6G 1C9, Canada (M.T.-S.); (B.S.)
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11
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Pierce JD, Segundo J, Derrick JL. Racial/Ethnic Differences in the Predictive Utility of Psychosocial Determinants of COVID-19 Vaccination Intentions. Am J Health Promot 2023; 37:988-992. [PMID: 37369621 PMCID: PMC10300626 DOI: 10.1177/08901171231186315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE To test whether the impact of subjective norms, race/ethnicity-specific descriptive norms, vaccine conspiracy beliefs, and prosocial concern on COVID-19 vaccination intentions differs by race/ethnicity for young adults. DESIGN Cross-sectional study. SETTING May-August 2021 in Texas. SUBJECTS Racially/ethnically diverse unvaccinated college students (N = 314). MEASURES COVID-19 vaccination intentions, theory-driven constructs (eg, perceived susceptibility), vaccine conspiracy beliefs, prosocial concern, and social norms. ANALYSIS Block-sequential multiple Tobit regression. RESULTS Results revealed three significant two-way interactions between race/ethnicity and (1) subjective norms, F (5, 251) = 2.28, P < .05; (2) COVID-19 vaccine conspiracy beliefs, F (5, 251) = 2.88, P < .05; and (3) prosocial concern, F (5, 251) = 2.61, P < .05. There was a positive association between subjective norms and intentions for European and African Americans, a positive association between prosocial concerns and intentions for European and multiracial/multiethnic Americans, and a negative association between conspiracy beliefs and intention for Hispanics. The interaction between race/ethnicity and race/ethnicity-specific descriptive norms was not significant, F (5, 251) = 1.09, P = .37. CONCLUSION Although based on a relatively small sample, our findings suggest the importance of culturally tailoring COVID-19 vaccination messages to correct conspiracy beliefs, signaling a positive subjective norm, and enhancing prosocial concerns for specific racial-ethnic groups.
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Affiliation(s)
- Jace D. Pierce
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Joahana Segundo
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jaye L. Derrick
- Department of Psychology, University of Houston, Houston, TX, USA
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12
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Dell’Imperio SG, Aboul-Hassan D, Batchelor R, Chambers-Peeple K, Clauw DJ, DeJonckheere M, Bergmans RS. Vaccine perceptions among Black adults with long COVID. ETHNICITY & HEALTH 2023; 28:853-873. [PMID: 37005013 PMCID: PMC10524107 DOI: 10.1080/13557858.2023.2191914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Low uptake of COVID vaccines within Black communities is a concern given the stark racial inequities associated with the pandemic. Prior research details COVID vaccine perceptions within the general population and Black communities specifically. However, Black individuals with long COVID may be more or less receptive to future COVID vaccination than their peers without long COVID. The impact of COVID vaccination on long COVID symptoms is still controversial, since some studies suggest that vaccination can improve long COVID symptoms, whereas other studies report no significant change in symptoms or a worsening of symptoms. In this study, we aimed to characterize the factors influencing perceptions of COVID vaccines among Black adults with long COVID to inform future vaccine-related policies and interventions. DESIGN We conducted 15 semi-structured, race-concordant interviews over Zoom with adults who reported physical or mental health symptoms that lingered for a month or more after acute COVID infection. We transcribed and anonymized the interviews and implemented inductive, thematic analysis to identify factors influencing COVID vaccine perceptions and the vaccine decision-making process. RESULTS We identified five themes that influenced vaccine perceptions: (1) Vaccine safety and efficacy; (2) Social implications of vaccination status; (3) Navigating and interpreting vaccine-related information; (4) Possibility of abuse and exploitation by the government and scientific community; and (5) Long COVID status. Safety concerns were amplified by long COVID status and mistrust in social systems due to mistreatment of the Black community. CONCLUSIONS Among the factors influencing COVID vaccine perceptions, participants reported a desire to avoid reinfection and a negative immune response. As COVID reinfection and long COVID become more common, achieving adequate uptake of COVID vaccines and boosters may require approaches that are tailored in partnership with the long COVID patient community.
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Affiliation(s)
- Samantha G. Dell’Imperio
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, MI, USA
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, USA
| | | | | | | | - Daniel J. Clauw
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- University of Michigan, Medical School, Department of Family Medicine, Ann Arbor, MI, USA
| | - Rachel S. Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, USA
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13
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Chipman SA, Meagher K, Barwise AK. A Public Health Ethics Framework for Populations with Limited English Proficiency. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-16. [PMID: 37379053 DOI: 10.1080/15265161.2023.2224263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.
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14
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Shearn C, Krockow EM. Reasons for COVID-19 vaccine hesitancy in ethnic minority groups: A systematic review and thematic synthesis of initial attitudes in qualitative research. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100210. [PMID: 36573229 PMCID: PMC9771578 DOI: 10.1016/j.ssmqr.2022.100210] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/11/2022] [Accepted: 12/16/2022] [Indexed: 04/22/2023]
Abstract
Despite being disproportionately affected by the COVID-19 pandemic, ethnic and racial minority groups show widespread vaccine hesitancy. Adherence to ongoing booster vaccine campaigns is required to contain future spread of the virus and protect health systems. This review aims to appraise and synthesise qualitative studies published from December 2021 to February 2022 addressing the issue for an in-depth exploration of initial COVID-19 vaccine hesitancy in minorities, including refugee, asylum seeker and migrant populations. A systematic literature search of five databases identified 15 eligible studies. Thematic synthesis identified three main themes of "institutional mistrust", "lack of confidence in vaccine and vaccine development process", and "lack of reliable information or messengers". Two minor themes included "complacency/perceived lack of need" and "structural barriers to vaccine access". "Institutional mistrust" permeated several other themes, demonstrating the need for culturally sensitive approaches. Applying our findings to the World Health Organisation's Three C Model of vaccine hesitancy, the "confidence" dimension appears to represent a disproportionately large barrier to vaccine uptake in ethnic minority groups. Indeed, nuanced adaptations of the model may be necessary to explain vaccine hesitancy in those groups. Further research is required to explore factors facilitating vaccine uptake to monitor changes in hesitancy over time.
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Affiliation(s)
- Christina Shearn
- School of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
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15
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Sharma E, Mondal S, Das S, Vrana VG. Scale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological Factors. Vaccines (Basel) 2023; 11:1052. [PMID: 37376441 DOI: 10.3390/vaccines11061052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Vaccination is the most cost-effective way to maintain population health. However, it can only be effective if widespread acceptance is held. The efficacy of COVID-19 vaccines depends on their favor. When countries start to vaccinate their citizens, there is a certain level of skepticism about the effectiveness of the vaccines. The hesitancy study on vaccines has gained momentum following the pandemic. However, few studies have examined the link between the psychological and sociodemographic factors influencing the fit. This paper proposes integrating the concepts of the information systems success and stimulus-organism-response into a cognitive fit theory framework to explore the integration of psychological and sociodemographic factors in the receivers' reactions (n = 1510). This study analyses the factors that influence the hesitancy of vaccines and the public's refusal in Asia and Europe. Receivers' reactions were assessed to various stimuli and we explored the link between psychological and sociodemographic elements and the concept of fit. Two surveys were conducted following the scale development of Mackenzie. The first was to develop the fit scale, while the second was to validate the fit scale. The results of the second survey were analyzed using structural equation modelling. The results indicate that the scale's fit development is valid and reliable. The quality of the vaccine information, the psychological characteristics of the vaccine system, and vaccine receivers' satisfaction are also beneficial factors for emotional and cognitive fit. Maintaining the vaccines' quality and efficiency can help improve the fit between sociodemographic and psychological characteristics. It can also enhance receivers' satisfaction and encourage continued vaccine administration. This study is regarded as one of the first to examine and develop an emotional and cognitive fit scale for practitioners and researchers.
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Affiliation(s)
- Eliza Sharma
- Symbiosis Institute of Business Management Bengaluru, Symbiosis International (Deemed University), Karnataka 560100, India
| | - Subhra Mondal
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Subhankar Das
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Vasiliki G Vrana
- Department of Business Administration, School of Economics and Administration, The Campus of Serres, International Hellenic University, 62124 Serres, Greece
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16
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Vincenzo JL, Spear MJ, Moore R, Purvis RS, Patton SK, Callaghan-Koru J, McElfish PA, Curran GM. Reaching late adopters: factors influencing COVID-19 vaccination of Marshallese and Hispanic adults. BMC Public Health 2023; 23:631. [PMID: 37013523 PMCID: PMC10068695 DOI: 10.1186/s12889-023-15468-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Marshallese and Hispanic communities in the United States have been disproportionately affected by COVID-19. Identifying strategies to reach late vaccine adopters is critical for ongoing and future vaccination efforts. We utilized a community-engaged approach that leveraged an existing community-based participatory research collaborative of an academic healthcare organization and Marshallese and Hispanic faith-based organizations (FBO) to host vaccination events. METHODS Bilingual Marshallese and Hispanic study staff conducted informal interviews with 55 participants during the 15-minute post-vaccination observation period and formal semi-structured interviews with Marshallese (n = 5) and Hispanic (n = 4) adults post-event to assess the implementation of community vaccine events at FBOs, with a focus on factors associated with the decision to attend and be vaccinated. Formal interview transcripts were analyzed using thematic template coding categorized with the socio-ecological model (SEM). Informal interview notes were coded via rapid content analysis and used for data triangulation. RESULTS Participants discussed similar factors influencing attitudes and behaviors toward receiving the COVID-19 vaccine. Themes included: (1) intrapersonal - myths and misconceptions, (2) interpersonal - protecting family and family decision-making, (3) community - trust of community location of events and influence of FBO members and leaders, (4) institutional - trust in a healthcare organization and bilingual staff, and (5) policy. Participants noted the advantages of vaccination delivery at FBOs, contributing to their decision to attend and get vaccinated. CONCLUSIONS The following strategies may improve vaccine-related attitudes and behaviors of Marshallese and Hispanic communities not only for the COVID-19 vaccine but also for other preventive vaccinations: 1) interpersonal-level - develop culturally-focused vaccine campaigns targeting the family units, 2) community-level - host vaccination events at convenient and/or trusted locations, such as FBOs, and engage community and/or FBO formal or lay leaders as vaccine ambassadors or champions, and 3) institutional-level - foster trust and a long-term relationship with the healthcare organization and provide bilingual staff at vaccination events. Future research would be beneficial to investigate the effects of replicating these strategies to support vaccine uptake among Marshallese and Hispanic communities.
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Affiliation(s)
- Jennifer L Vincenzo
- College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Marissa J Spear
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Susan K Patton
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Jennifer Callaghan-Koru
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA.
| | - Geoffrey M Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
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17
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Cénat JM, Moshirian Farahi SMM, Bakombo SM, Dalexis RD, Pongou R, Caulley L, Yaya S, Etowa J, Venkatesh V. Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system. J Med Virol 2023; 95:e28738. [PMID: 37185858 DOI: 10.1002/jmv.28738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic disproportionately affected Black communities in Canada in terms of infection and mortality rates compared to the general population. Despite these facts, Black communities are among those with the highest level of COVID-19 vaccine mistrust (COVID-19 VM). We collected novel data to analyze the sociodemographic characteristics and factors associated with COVID-19 VM among Black communities in Canada. A survey was conducted among a representative sample of 2002 Black individuals (51.66% women) aged 14-94 years (M = 29.34; SD = 10.13) across Canada. Vaccine mistrust was assessed as the dependent variable and conspiracy theories, health literacy, major racial discrimination in healthcare settings, and sociodemographic characteristics of participants were assessed as independent variables. Those with a history of COVID-19 infection had higher COVID-19 VM score (M = 11.92, SD = 3.88) compared to those with no history of infection (M = 11.25, SD = 3.83), t (1999) = -3.85, p < 0.001. Participants who reported having experienced major racial discrimination in healthcare settings were more likely to report COVID-19 VM (M = 11.92, SD = 4.03) than those who were not (M = 11.36, SD = 3.77), t (1999) = -3.05, p = 0.002. Results also showed significant differences for age, education level, income, marital status, provinces, language, employment status, and religion. The final hierarchical linear regression showed that conspiracy beliefs (B = 0.69, p < 0.001) were positively associated with COVID-19 VM, while health literacy (B = -0.05, p = 0.002) was negatively associated with it. The mediated moderation model showed that conspiracy theories completely mediated the association between racial discrimination and vaccine mistrust (B = 1.71, p < 0.001). This association was also completely moderated by the interaction between racial discrimination and health literacy (B = 0.42, p = 0.008), indicating that despite having a high level of health literacy, those who experienced major racial discrimination in health services developed vaccine mistrust. This first study on COVID-19 VM exclusively among Black individuals in Canada provides data that can significantly impact the development of tools, trainings, strategies, and programs to make the health systems free of racism and increase their confidence in vaccination for COVID-19 and other infectious diseases.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada
| | | | - Schwab Mulopo Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ontario, Canada
| | - Vivek Venkatesh
- Department of Art Education, Concordia University, Quebec, Montreal, Canada
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18
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Skinner NA, Sanders K, Lopez E, Sotz Mux MS, Abascal Miguel L, Vosburg KB, Johnston J, Diamond-Smith N, Kraemer Diaz A. Barriers to COVID-19 vaccine acceptance to improve messages for vaccine uptake in indigenous populations in the central highlands of Guatemala: a participatory qualitative study. BMJ Open 2023; 13:e067210. [PMID: 36707110 PMCID: PMC9884572 DOI: 10.1136/bmjopen-2022-067210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns. METHODS In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Sololá. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts. RESULTS We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government. CONCLUSION When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.
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Affiliation(s)
- Nadine Ann Skinner
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly Sanders
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Emily Lopez
- Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | | | - Lucía Abascal Miguel
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kathryn B Vosburg
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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19
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Valero-Martínez C, Martínez-Rivera C, Zhen-Duan J, Fukuda M, Alegría M. Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults. Geriatrics (Basel) 2023; 8:17. [PMID: 36826359 PMCID: PMC9956127 DOI: 10.3390/geriatrics8010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.
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Affiliation(s)
- Carla Valero-Martínez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychology, Faculty of Social Sciences, Río Piedras Campus, University of Puerto Rico, San Juan, PR 00925, USA
| | - Christopher Martínez-Rivera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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20
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Latkin C, Dayton L, Miller J, Eschliman E, Yang J, Jamison A, Kong X. Trusted information sources in the early months of the COVID-19 pandemic predict vaccination uptake over one year later. Vaccine 2023; 41:573-580. [PMID: 36513535 PMCID: PMC9722679 DOI: 10.1016/j.vaccine.2022.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION COVID-19 vaccine uptake has been a major barrier to stopping the pandemic in many countries with vaccine access. This longitudinal study examined the capability to predict vaccine uptake from data collected early in the pandemic before vaccines were available. METHODS 493 US respondents completed online surveys both at baseline (March 2020) and wave 6 (June 2021), while 390 respondents completed baseline and wave 7 (November 2021) surveys. The baseline survey assessed trust in sources of COVID-19 information, social norms, perceived risk of COVID-19, skepticism about the pandemic, prevention behaviors, and conspiracy beliefs. Multivariable logistic models examined factors associated with the receipt of at least one COVID-19 vaccine dose at the two follow-ups. RESULTS In the adjusted model of vaccination uptake at wave 6, older age (aOR = 1.02, 95 %CI = 1.00-1.04) and greater income (aOR = 1.69, 95 %CI = 1.04-2.73) was associated with positive vaccination status. High trust in state health departments and mainstream news outlets at baseline were positively associated with vaccination at wave 6, while high trust in the Whitehouse (aOR = 0.42, 95 %CI = 0.24-0.74) and belief that China purposely spread the virus (aOR = 0.66, 95 %CI = 0.46-0.96) at baseline reduced the odds of vaccination. In the adjusted model of vaccination uptake at wave 7, increased age was associated with positive vaccination status, and Black race (compared to white) was associated with negative vaccination status. High trust in the CDC and mainstream news outlets at baseline were both associated with being vaccinated at wave 7, while high trust in the Whitehouse (aOR = 0.24, 95 %CI = 0.11-0.51) and belief that the virus was spread purposefully by China (aOR = 0.60, 95 %CI = 0.39-0.93) were negatively associated with vaccination. CONCLUSIONS These findings indicated that vaccine uptake could be predicted over a year earlier. Trust in specific sources of COVID-19 information were strong predictors, suggesting that future pandemic preparedness plans should include forums for news media, public health officials, and diverse political leaders to meet and develop coherent plans to communicate to the public early in a pandemic so that antivaccine attitudes do not flourish and become reinforced.
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States,Division of Infectious Diseases, Johns Hopkins University, School of Medicine, United States,Corresponding author at: Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Lauren Dayton
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Jacob Miller
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Evan Eschliman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Jingyan Yang
- Department of Political Science, Columbia University, United States
| | - Amelia Jamison
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins University, School of Medicine, United States
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21
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Herry AM, Greaves D, Smith P, Toledo NA, Wildman A, Wildman T, Browne R, Chen M, Jones M, Aymat S. Facilitators of and barriers to COVID-19 vaccination in Grenada: a qualitative study. Rev Panam Salud Publica 2023; 47:e44. [PMID: 36945250 PMCID: PMC10022831 DOI: 10.26633/rpsp.2023.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/24/2022] [Indexed: 03/19/2023] Open
Abstract
Objectives To identify the factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy in Grenada. Methods A phenomenological study was conducted using semi-structured interviews at vaccination and pop-up testing clinics during a spike in COVID-19 cases on the island. Interview questions were developed using the health belief model related to perceived threat of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action. Data were analyzed using a deductive approach to identify themes, categories, and subcategories. Results Twenty-five interviews were transcribed and coded. In all, 68% of participants were unvaccinated, 12% were partially vaccinated, and 20% were fully vaccinated. Data analysis revealed two main themes: facilitators and barriers. Factors more likely to encourage vaccination (facilitators) included trust in medical advice and vaccine efficacy, social responsibility, and vaccine mandates for travel, employment, and social activities. Factors hindering vaccination (barriers) included: perceived low threat of COVID-19; preference for natural remedies; concerns about contraindications because of underlying health conditions; fear; mistrust of vaccines and related messaging; vaccine accessibility; and the many different information sources. Conclusions Overcoming vaccine hesitancy is key to combating the detrimental effects of COVID-19 in Grenada. Public health interventions and policies that address barriers and capitalize on facilitators can increase vaccine uptake.
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Affiliation(s)
- Arlette M. Herry
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
- Arlette M. Herry,
| | - Damian Greaves
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Pauline Smith
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Nilo A. Toledo
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Ariel Wildman
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Trent Wildman
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Rosheem Browne
- McGovern Medical School at The University of Texas Health Science Center at HoustonTexasUnited States of AmericaMcGovern Medical School at The University of Texas Health Science Center at Houston, Texas, United States of America.
| | - Madison Chen
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Matthew Jones
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
| | - Sebastian Aymat
- St George’s UniversitySt GeorgeGrenadaSt George’s University, St George, Grenada.
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Atrooz F, Majd Z, Alrousan G, Zeidat S, Abuelezam NN, Abughosh S, Salim S. Acceptance of COVID-19 vaccination in a sample of Middle Eastern and North African (MENA) Houston residents. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001441. [PMID: 36962927 PMCID: PMC10021233 DOI: 10.1371/journal.pgph.0001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND COVID-19 vaccination has averted a significant number of deaths in the United States, but vaccination hesitancy continues to be a problem. Therefore, examining vaccination acceptance and/or hesitancy in local communities is critical. METHODS A quantitative survey and a multivariable logistic regression model was utilized to determine predictors of COVID-19 vaccination in Middle Eastern and North African (MENA) origin Houston residents. The outcome of interest was COVID-19 vaccination status (vaccinated versus not vaccinated). Covariates included: demographics, health, and COVID-19 factors. Statistical analyses included SAS version 9.4 at a priori significance level of 0.05. RESULTS The overall vaccine acceptance rate was significantly high in this population subset (N = 366), with 77.60% vaccinated, and 22.40% not vaccinated. MENA individuals with some college degrees were less likely to report vaccination than those with a graduate degree [Odds Ratio (OR): 0.18; 95% Confidence Interval (CI): 0.04, 0.77]. Homeowners were more likely to get vaccinated than renters (OR: 2.58; 95%CI: 1.17, 5.68). Individuals practicing Islamic faith were more likely to get vaccinated than other religious affiliations (OR: 3.26; 95%CI: 1.15, 9.19). Individuals with hypertension were less likely to get vaccinated than those without it (OR: 0.34; 95%CI: 0.13, 0.92), and those with anxiety were more likely to get vaccinated than those without anxiety (OR: 4.23; 95%CI: 1.68, 10.64). CONCLUSIONS Health status, education level, financial stability, and religious affiliation are some of the determining factors that potentially influence vaccination acceptance/hesitancy among the MENA community.
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Affiliation(s)
- Fatin Atrooz
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Zahra Majd
- Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Ghalya Alrousan
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Sarah Zeidat
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Nadia N Abuelezam
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, United States of America
| | - Susan Abughosh
- Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
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Alfano G, Fontana F, Giovanella S, Morisi N, Amurri A, Ligabue G, Guaraldi G, Ferrari A, Cappelli G, Magistroni R, Gregorini M, Donati G. Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience. Clin Exp Nephrol 2023; 27:171-178. [PMID: 36326942 PMCID: PMC9631594 DOI: 10.1007/s10157-022-02283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There are limited data on the effects of COVID-19 on peritoneal dialysis (PD) patients. This study aimed to describe the impact of COVID-19 on the PD population. METHODS A monocentric retrospective observational study was conducted on 146 consecutive PD patients followed from January 2020 to March 2022 at the University Hospital of Modena, Italy. RESULTS Twenty-seven (18.4%) PD patients experienced 29 episodes of SARS-CoV-2 infection, corresponding to an incidence rate of 0.16 episodes/patient-year. Median age of COVID-19 patients was 60.4 (interquartile range [IQR] 50.2-66.5) years. In unvaccinated patients (n. 9), COVID-19 was always symptomatic and manifested with fever (100%) and cough (77.7%). COVID-19 caused hospital admission of three (33.3%) patients and two (22.2%) died of septic shock. COVID-19 was symptomatic in 83.3% of vaccinated subjects (n.18) and manifested with fever (61.1%) and cough (55.6%). Hospital admission occurred in 27.8% of the subjects but all were discharged home. Median SARS-CoV-2 shedding was 32 and 26 days in the unvaccinated and vaccinated groups, respectively. At the end of the follow-up, COVID-19 triggered the shift from PD to HD in two subjects without affecting the residual renal function of the remaining patients. Overall, COVID-19 caused an excess death of 22.2%. COVID-19 vaccination refusal accounted for only 1.6% in this cohort of patients. CONCLUSION COVID-19 incident rate was 0.16 episodes/patient-year in the PD population. About one-third of the patients were hospitalized for severe infection. Fatal outcome occurred in two (7.4%) unvaccinated patients. A low vaccination refusal rate was observed in this population.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy
| | - Silvia Giovanella
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolo Morisi
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Amurri
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - Gianni Cappelli
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy ,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Mariacristina Gregorini
- Nephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplant Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, via del Pozzo 71, 41124 Modena, Italy ,Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
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Naveed Z, Li J, Spencer M, Wilton J, Naus M, García HAV, Otterstatter M, Janjua NZ. Observed versus expected rates of myocarditis after SARS-CoV-2 vaccination: a population-based cohort study. CMAJ 2022; 194:E1529-E1536. [PMID: 36410749 PMCID: PMC9828950 DOI: 10.1503/cmaj.220676] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postmarketing evaluations have linked myocarditis to SARS-CoV-2 mRNA vaccines. We sought to estimate the incidence of myocarditis after mRNA vaccination against SARS-CoV-2, and to compare the incidence with expected rates based on historical background rates in British Columbia. METHODS We conducted an observational study using population health administrative data from the BC COVID-19 Cohort from Dec. 15, 2020, to Mar. 10, 2022. The primary exposure was any dose of an mRNA vaccine against SARS-CoV-2. The primary outcome was incidence of hospital admission or emergency department visit for myocarditis or myopericarditis within 7 and 21 days postvaccination, calculated as myocarditis rates per 100 000 mRNA vaccine doses, expected rates of myocarditis cases and observedto-expected ratios. We stratified analyses by age, sex, vaccine type and dose number. RESULTS We observed 99 incident cases of myocarditis within 7 days (0.97 cases per 100 000 vaccine doses; observed v. expected ratio 14.81, 95% confidence interval [CI] 10.83-16.55) and 141 cases within 21 days (1.37 cases per 100 000 vaccine doses; observed v. expected ratio 7.03, 95% CI 5.92-8.29) postvaccination. Cases of myocarditis per 100 000 vaccine doses were higher for people aged 12-17 years (2.64, 95% CI 1.54-4.22) and 18-29 years (2.63, 95% CI 1.94-3.50) than for older age groups, for males compared with females (1.64, 95% CI 1.30-2.04 v. 0.35, 95% CI 0.21-0.55), for those receiving a second dose compared with a third dose (1.90, 95% CI 1.50-2.39 v. 0.76, 95% CI 0.45-1.30) and for those who received the mRNA-1273 (Moderna) vaccine compared with the BNT162b2 (Pfizer-BioNTech) vaccine (1.44, 95% CI 1.06-1.91 v. 0.74, 95% CI 0.56-0.98). The highest observed-to-expected ratio was seen after the second dose among males aged 18-29 years who received the mRNA-1273 vaccine (148.32, 95% CI 95.03-220.69). INTERPRETATION Although absolute rates of myocarditis were low, vaccine type, age and sex are important factors to consider when strategizing vaccine administration to reduce the risk of postvaccination myocarditis. Our findings support the preferential use of the BNT162b2 vaccine over the mRNA-1273 vaccine for people aged 18-29 years.
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Affiliation(s)
- Zaeema Naveed
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Julia Li
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Michelle Spencer
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - James Wilton
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Monika Naus
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Héctor Alexander Velásquez García
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Michael Otterstatter
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
| | - Naveed Zafar Janjua
- School of Population and Public Health (Naveed), University of British Columbia; British Columbia Centre for Disease Control (Li, Spencer, Wilton, Naus, Velásquez García, Otterstatter, Janjua), Vancouver, BC
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Adeagbo M, Olukotun M, Musa S, Alaazi D, Allen U, Renzaho AMN, Sekyi-Otu A, Salami B. Improving COVID-19 Vaccine Uptake among Black Populations: A Systematic Review of Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11971. [PMID: 36231270 PMCID: PMC9565689 DOI: 10.3390/ijerph191911971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 05/28/2023]
Abstract
Given the growing body of evidence on COVID-19 vaccine hesitancy among Black populations, the aim of this systematic review was to identify the interventions and strategies used to improve COVID-19 vaccine confidence and uptake among Black populations globally. To identify relevant studies, we conducted a systematic review of the literature based on a systematic search of 10 electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Cochrane Library, Web of Science, Sociological Abstracts, Dissertations and Theses Global, and SocINDEX. We screened a total of 1728 records and included 14 peer-reviewed interventional studies that were conducted to address COVID-19 vaccine hesitancy among Black populations. A critical appraisal of the included studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The intervention strategies for increasing COVID-19 vaccine uptake were synthesized into three major categories: communication and information-based interventions, mandate-based interventions, and incentive-based interventions. Interventions that incorporated communication, community engagement, and culturally inclusive resources significantly improved vaccine uptake among Black populations, while incentive- and mandate-based interventions had less impact. Overall, this systematic review revealed that consideration of the sociocultural, historical, and political contexts of Black populations is important, but tailored interventions that integrate culture-affirming strategies are more likely to decrease COVID-19 vaccine hesitancy and increase uptake among Black populations.
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Affiliation(s)
- Morolake Adeagbo
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mary Olukotun
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Salwa Musa
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Dominic Alaazi
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Upton Allen
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Andre M. N. Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Ato Sekyi-Otu
- Department of Surgery, University of Toronto, Toronto, ON M5S 2J7, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Vaccine Hesitancy during the Coronavirus Pandemic in South Tyrol, Italy: Linguistic Correlates in a Representative Cross-Sectional Survey. Vaccines (Basel) 2022; 10:vaccines10101584. [PMID: 36298448 PMCID: PMC9607221 DOI: 10.3390/vaccines10101584] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background: German is a minority language in Italy and is spoken by the majority of the inhabitants of the Autonomous Province of Bolzano, South Tyrol. Linguistic group membership in South Tyrol is an established determinant of health information-seeking behavior. Because the COVID-19 incidence and vaccination coverage in the second year of the pandemic in Italy was the worst in South Tyrol, we investigated whether linguistic group membership is related to COVID-19 vaccine hesitancy. Methods: A cross-sectional survey was conducted on a probability-based sample of 1425 citizens from South Tyrol in March 2021. The questionnaire collected information on socio-demographics, including linguistic group membership, comorbidities, COVID-19-related experiences, conspiracy thinking, well-being, altruism, and likelihood of accepting the national vaccination plan. Multiple logistic regression analyses were performed to identify the significant predictors of vaccine hesitancy. Results: Overall, 15.6 percent of the sample reported vaccine hesitancy, which was significantly higher among German speakers than among other linguistic groups. Increased hesitancy was mostly observed in young age, the absence of chronic disease, rural residence, a worsened economic situation, mistrust in institutions, and conspiracy thinking. In the multiple logistic regression analyses, linguistic group membership was not an independent predictor of vaccine hesitancy. Conclusion: Although German is a minority language in Italy and COVID-19 vaccine hesitancy was higher in the German native language group than in the Italian, linguistic group membership was not an independent predictor of hesitancy in the autonomous province. Known predictors of vaccine hesitancy are distributed unevenly across language groups. Whether language group-specific intervention strategies to promote vaccine hesitancy are useful requires further study.
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Gilmore B, Gerlach N, Abreu Lopes C, Diallo AA, Bhattacharyya S, de Claro V, Ndejjo R, Nyamupachitu Mago E, Tchetchia A. Community engagement to support COVID-19 vaccine uptake: a living systematic review protocol. BMJ Open 2022; 12:e063057. [PMID: 36127122 PMCID: PMC9490295 DOI: 10.1136/bmjopen-2022-063057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/18/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Widespread vaccination against COVID-19 is one of the most effective ways to control, and ideally, end the global COVID-19 pandemic. Vaccine hesitancy and vaccine rates vary widely across countries and populations and are influenced by complex sociocultural, political, economic and psychological factors. Community engagement is an integral strategy within immunisation campaigns and has been shown to improve vaccine acceptance. As evidence on community engagement to support COVID-19 vaccine uptake is emerging and constantly changing, research that lessens the knowledge-to-practice gap by providing regular and up-to-date evidence on current best-practice is essential. METHODS AND ANALYSIS A living systematic review will be conducted which includes an initial systematic review and bimonthly review updates. Searching and screening for the review and subsequent updates will be done in four streams: a systematic search of six databases, grey literature review, preprint review and citizen sourcing. The screening will be done by a minimum of two reviewers at title/abstract and full-text in Covidence, a systematic review management software. Data will be extracted across predefined fields in an excel spreadsheet that includes information about article characteristics, context and population, community engagement approaches, and outcomes. Synthesis will occur using the convergent integrated approach. We will explore the potential to quantitatively synthesise primary outcomes depending on heterogeneity of the studies. ETHICS AND DISSEMINATION The initial review and subsequent bimonthly searches and their results will be disseminated transparently via open-access methods. Quarterly briefs will be shared on the reviews' social media platforms and across other interested networks and repositories. A dedicated web link will be created on the Community Health-Community of Practice site for sharing findings and obtaining feedback. A mailing list will be developed and interested parties can subscribe for updates. PROSPERO REGISTRATION NUMBER CRD42022301996.
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Affiliation(s)
- Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Nina Gerlach
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Claudia Abreu Lopes
- International Institute for Global Health United Nations University, Kuala Lumpur, Malaysia
| | - Alpha A Diallo
- READ-GROUP, Conakry, Guinea
- Health Research Ethics Committee, Conakry, Guinea
| | - Sanghita Bhattacharyya
- Public Health Foundation of India, Gurugram, Haryana, India
- Community Health-Community of Practice Collectivity, United Nations Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Vergil de Claro
- RTI International, Pasig City, Philippines
- Evidence for Health, Pasig City, Philippines
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Adalbert Tchetchia
- Community Health-Community of Practice Collectivity, United Nations Children's Fund (UNICEF) Headquarters, New York City, New York, USA
- Expanded Programme on Immunization, Yaounde, Cameroon
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Kafadar AH, Tekeli GG, Jones KA, Stephan B, Dening T. Determinants for COVID-19 vaccine hesitancy in the general population: a systematic review of reviews. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-17. [PMID: 36160668 PMCID: PMC9483252 DOI: 10.1007/s10389-022-01753-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022]
Abstract
Aim Although multiple COVID-19 vaccines are approved for global use, vaccine hesitancy poses a substantial risk for global health. Therefore, the aim of this umbrella review is to identify those factors that influence COVID-19 vaccination hesitancy in the general population. This is necessary to improve the effectiveness of future vaccination programmes. Methods PubMed, Embase, Scopus, PsycInfo, the Cochrane Database of Systematic Reviews, Epistemonikos, and PROSPERO (International Prospective Register of Systematic Reviews) were searched on December 21, 2021. This review included reviews which investigated factors of intention, willingness, or hesitancy with regard to the COVID-19 vaccination in adult populations, with no restrictions on setting. Content-based structure was used to synthesise the extracted data. The findings were presented based on the Strategic Advisory Group of Experts (SAGE) Working Group Model for vaccine hesitancy. Results A total of 3,392 studies were identified, of which 31 met the inclusion criteria. The most frequently documented factors associated with COVID-19 vaccine hesitancy included contextual factors, such as sex, age, and social inequalities; individual and group factors, such as trust in the healthcare system, public health authorities, and governments, and history of vaccination; vaccine-specific factors, such as concern for vaccine safety, perceived vaccine barriers, perceived effectiveness of vaccines, and concern about the rapid development of the vaccine; and disease-specific factors, such as fear of being infected with COVID-19, perceived severity of COVID-19, and knowledge of COVID-19. Conclusion There are multiple factors associated with COVID-19 vaccine hesitancy. Our findings lay the foundation to further understand COVID-19 vaccination uptake and provide possible targets for intervention programmes. However, there are gaps in research concerning certain populations, including vaccination in people with mental disorders. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01753-9.
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Affiliation(s)
- Aysegul Humeyra Kafadar
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU UK
| | - Gamze Gizem Tekeli
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Katy A. Jones
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Blossom Stephan
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Quinlan EJ, Chubet R, Leonardi P. A novel SARS-CoV-2 subunit vaccine engineered on an immune-activating platform technology. Hum Vaccin Immunother 2022; 18:2062971. [PMID: 35801956 DOI: 10.1080/21645515.2022.2062971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While there are several SARS-CoV-2 vaccines currently available, additional options must be provided that are safe, effective, and affordable for the entire global population. We have developed a novel immune activating platform technology that will fill this need. This recombinant platform protein is produced in insect cells using baculoviral expression technology similar to what is currently used for several other approved vaccines as well as employed by myriad GMP facilities globally. Thus, infrastructure exists for rapid scale up following initial optimizations. Here we report initial results for a SARS-CoV-2 vaccine (OMN008) based on our platform technology. Unadjuvanted OMN008 vaccination resulted in robust antigenicity and neutralization. Additionally, OMN008 vaccination induced a specific CD8 T-cell response. All of these results taken together indicate OMN008 may be an excellent candidate to fill gaps left by the currently available vaccines. Further testing is necessary to fully optimize production; however, overall cost of production should remain low given the simple formulation of this recombinant platform.
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Affiliation(s)
| | - Richard Chubet
- Research and Development, OmniCyte LLC, Guilford, CT, USA
| | - Peter Leonardi
- Research and Development, OmniCyte LLC, Guilford, CT, USA
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Yehualashet DE, Seboka BT, Tesfa GA, Mamo TT, Yawo MN, Hailegebreal S. Prevalence and Determinants of COVID-19 Vaccine Hesitancy Among the Ethiopian Population: A Systematic Review. Healthc Policy 2022; 15:1433-1445. [PMID: 35937966 PMCID: PMC9346414 DOI: 10.2147/rmhp.s368057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Although vaccination is the most effective way to end the COVID-19 pandemic, there are growing concerns that vaccine hesitancy may undermine its effectiveness. In Ethiopia, vaccine hesitancy forms a major challenge to the uptake of COVID-19 vaccines. This systematic review examined the prevalence and determinants of the COVID-19 vaccine hesitancy among the Ethiopian population. Methods A systematic search of articles was conducted in PubMed, EBSCO, Google Scholar, and Semantic Scholar. Studies that evaluated the prevalence and determinants of COVID-19 vaccine hesitancy in Ethiopia were included. The identified determinants of COVID-19 vaccine hesitancy were analyzed based on the frequency of occurrence in the included studies. Results The overall COVID-19 vaccine hesitancy level in the Ethiopian population ranged from 14.1% to 68.7%. The high COVID-19 vaccine hesitancy rate observed in this study was due to contextual factors, individual factors, and vaccine-specific factors. Young age, female sex, living in rural areas, lack of adequate information, and lower education are the most common contextual determinants of the COVID-19 vaccine hesitancy. Lack of awareness about the COVID-19 vaccine, low risk of COVID-19, poor adherence to COVID-19 prevention strategies, and negative attitude towards the COVID-19 vaccine are the most frequently reported personal factors. Common vaccine-specific determinants of COVID-19 vaccine hesitation are the side effects of the vaccine and doubts about its effectiveness of the vaccine. Conclusion Our review showed that COVID-19 vaccine hesitancy remains highly prevalent and varied across regions of Ethiopia, with a wide variety of factors associated with it. Potential interventions on the benefits of vaccination and the adverse effects of vaccine rejection are crucial to enhance COVID-19 vaccine uptake among the Ethiopian population.
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Affiliation(s)
- Delelegn Emwodew Yehualashet
- School of Public Health, Dilla University, Dilla, Ethiopia
- Correspondence: Delelegn Emwodew Yehualashet, School of Public Health, Dilla University, Dilla, Ethiopia, Tel +251 976061907, Email
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Juarez R, Phankitnirundorn K, Okihiro M, Maunakea AK. Opposing Role of Trust as a Modifier of COVID-19 Vaccine Uptake in an Indigenous Population. Vaccines (Basel) 2022; 10:968. [PMID: 35746577 PMCID: PMC9229995 DOI: 10.3390/vaccines10060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/26/2023] Open
Abstract
Native Hawaiians and other Pacific Islanders (NHPIs) were disproportionately impacted by COVID-19 and remain significantly under-vaccinated against SARS-CoV-2. To understand vaccine hesitancy, we surveyed 1124 adults residing in a region with one of the lowest vaccination rates in Hawaii during our COVID-19 testing program. Probit regression analysis revealed that race/ethnicity was not directly associated with the probability of vaccine uptake. Instead, a higher degree of trust in official sources of COVID-19 information increased the probability of vaccination by 20.68%, whereas a higher trust in unofficial sources decreased the probability of vaccination by 12.49% per unit of trust. These results revealed a dual and opposing role of trust on vaccine uptake. Interestingly, NHPIs were the only racial/ethnic group to exhibit a significant positive association between trust in and consumption of unofficial sources of COVID-19 information, which explained the vaccine hesitancy observed in this indigenous population. These results offer novel insight relevant to COVID-19 mitigation efforts in minority populations.
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Affiliation(s)
- Ruben Juarez
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
| | - Krit Phankitnirundorn
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - Alika K. Maunakea
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
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Fieselmann J, Annac K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany. BMC Public Health 2022; 22:846. [PMID: 35484619 PMCID: PMC9046705 DOI: 10.1186/s12889-022-13265-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jana Fieselmann
- Faculty of Health, School of Medicine, Health Services Research, Witten/Herdecke University, Witten, Germany
| | - Kübra Annac
- Faculty of Health, School of Medicine, Health Services Research, Witten/Herdecke University, Witten, Germany
| | - Fabian Erdsiek
- Faculty of Health, School of Medicine, Health Services Research, Witten/Herdecke University, Witten, Germany
| | - Yüce Yilmaz-Aslan
- Faculty of Health, School of Medicine, Health Services Research, Witten/Herdecke University, Witten, Germany
- Faculty of Health Sciences, Nursing and Health Services Research, Bielefeld University, Bielefeld, Germany
- Faculty of Health Sciences, Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, Health Services Research, Witten/Herdecke University, Witten, Germany
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