Attitudes and beliefs of healthcare workers about influenza vaccination

Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico

Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.

Knowledge and attitudes of healthcare workers about influenza vaccination

BACKGROUND

Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination.

METHODS

We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study.

RESULTS

A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs.

CONCLUSION

Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.

Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine

BACKGROUND

This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage.

METHODS

Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023.

RESULTS

The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic.

CONCLUSIONS

The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.

Healthcare workers' perspectives on mandatory influenza vaccination: a scoping review

Background: Vaccination is efficacious at preventing influenza disease transmission, morbidity and mortality. Benefits of influenza vaccination for healthcare workers (HCW) are emphasized, yet vaccine uptake among HCW remains suboptimal. Mandatory vaccination programs may increase influenza vaccine uptake, however, attitudes and beliefs of HCW towards these mandates are not well known.Aims: This scoping review examined the attitudes and beliefs of HCW to ascertain the barriers and enablers to the implementation and acceptance of mandatory vaccination programs in healthcare settings.Design: Scoping review, guided by the PRISMA Extension for Scoping Reviews.Methods: Literature published between 2019 and 2023 was reviewed from five electronic databases, between June and October 2023.Data sources: Quantitative, qualitative and mixed-methods studies were obtained. Studies were limited to full-text English articles, published within peer-reviewed journals over the last five years. Data were extracted by both authors and documented using a modified version of the JBI's scoping review data extraction instrument, and analyzed thematically.Results: The original search yielded 319 articles. Forty-two articles were screened, with 10 studies included. Most HCW had negative views towards mandatory influenza vaccination, influenced by geographical location, age and discipline. The protection of patients and affordability/accessibility of vaccination were described as enablers to the acceptance of mandatory measures. The belief that mandatory vaccination was a violation of autonomy and misconceptions concerning influenza transmission, vaccine mechanism of action, side effects and effectiveness, were described as common barriers.Conclusions: Health services must carefully consider the context in which mandatory vaccination programs are implemented and employ strategies that incorporate education and promote vaccine accessibility, affordability and HCW autonomy. The quality of evidence retrieved was moderate to poor, with high heterogeneity between studies. Minimal Australian research was evident, limiting the generalisability of findings. These results should be interpreted with caution and further high-quality research is recommended.

Peri-Pandemic Acceptance of Influenza and COVID-19 Vaccination by Swiss Healthcare Workers in Primary Care 2020/21: A Cross-Sectional Study

Objectives: To assess and compare influenza and COVID-19 vaccination uptake of Swiss healthcare workers (HCWs) in primary care 2020/21. Methods: Influenza and COVID-19 vaccination uptake and recommendation behaviours of HCWs in the primary care were assessed using an online semi-structured questionnaire. Associations between vaccination rates and age, language, gender, profession, vaccination history, vaccination training and recommendation behaviours were evaluated using descriptive and multivariable logistic regression analyses. Results: Vaccinated against COVID-19 in 2020/21 were 91.8% of the 1,237 participating HCWs, while 60.1% were vaccinated against influenza. Physicians and pharmacists presented the highest influenza vaccination rates (87.3%, 73.7%, respectively) compared to nurses (45.8%) and medical practice assistants (52.5%) while COVID-19 vaccination rates were high across all professions. Influenza and COVID-19 vaccination rates were significantly associated with age, profession, vaccination history, vaccination training and recommendation behaviours. Conclusion: Acceptance for influenza vaccination has increased during the pandemic but is lower than that for COVID-19 among the HCWs. Demographics, vaccination status and vaccination training impact the vaccination behaviour among HCWs and should be considered in future campaigns to increase vaccination uptake.

Identifying reasons for non-acceptance of influenza vaccine in healthcare workers: an observational study using declination form data

BACKGROUND

Healthcare workers are sometimes required to complete a declination form if they choose not to accept the influenza vaccine. We analysed the declination data with the goal of identifying barriers to vaccination uptake across seasons, staff groups, and pre- and post- arrival of COVID-19.

METHODS

Reasons for declining the vaccine were gathered from N = 2230 declination forms, collected over four influenza seasons, 2017/2018, 2018/2019, 2019/2020 and 2020/2021, from a single health board in the UK. Reasons were classified according to ten categories and the resulting distribution analysed across year and staff groups. A further analysis considered the two most prevalent categories in more detail.

RESULTS

Fear of adverse reactions and Lack of perception of own risk were identified as primary reasons for not accepting the vaccine across time and across staff groups. However, there was no evidence that Lack of concern with influenza, or Doubts about vaccine efficacy was prevalent, contrary to previous findings. Overall, reasons fitted a pattern of underestimating risk associated with influenza and overestimating risk of minor adverse reactions. There were also differences across years, χ2(24) = 123, p < .001. In particular, there were relatively fewer Lack of perception of own risk responses post-COVID-19 arrival than before, χ2(8) = 28.93, p = .002.

CONCLUSION

This study shows that data collected from declination forms yields sensible information concerning vaccine non-acceptance without the difficulties of retrospective or pre-emptive reasoning suffered by questionnaires. Our findings will aid messaging campaigns designed to encourage uptake of the influenza vaccine in healthcare workers. In particular, we argue for an approach focused on risk perception rather than correction of straightforward misconceptions.

A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff

Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff.

METHOD

We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff.

RESULTS

We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources).

CONCLUSION

Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Nationwide Survey on Seasonal Influenza Vaccination among Health Care Workers during the COVID-19 Pandemic in Greece: Determinants, Barriers and Peculiarities

BACKGROUND

Seasonal influenza vaccination (SIV) of health care workers (HCWs) is critical in protecting patients' and HCWs' health. Our objective was to examine HCW SIV coverage and related determinants.

METHODS AND MATERIALS

A nationwide cross-sectional questionnaire survey was conducted among HCWs during the first half of 2021. The questionnaire (online or paper-based) included knowledge, attitude and practice questions regarding SIV, COVID-19 vaccines and vaccination.

RESULTS

Out of 6500 questionnaires administered, 2592 were completed (response rate: 39.9%). SIV coverage reached 69.4% (95% CI: 67.6-71.2%) based on self-reported vaccine uptake. Nurses and administrative staff were found to be more skeptical and have lower vaccine acceptance in comparison with physicians (aOR = 0.66 and aQR = 0.59, respectively). Other SIV hesitancy risk factors included working in secondary health care (aOR = 0.59) and working in northern Greece (aQR = 0.66). Determinants for SIV acceptance included being or living with high-risk people due to medical history (aOR = 1.84 and aOR = 1.46, respectively), positive attitudes towards routine vaccinations (aOR: 1.86), knowledge about COVID-19 vaccines (aOR = 1.53) and COVID-19 vaccine uptake (aOR = 3.45). The primary reason for SIV refusal was low risk perception (58.7%).

CONCLUSIONS

SIV coverage (2020/2021) was relatively high, but remained far from formal recommendations. Specific occupational groups were skeptical and low-risk perception was the main reason for vaccine refusal. Targeted policies should be developed and enforced.

Factors influencing healthcare professionals' confidence in vaccination in Europe: a literature review

Health-care professionals (HCPs) have a fundamental role in vaccination, their own beliefs and attitudes affecting both their uptake and recommendation of vaccines. This literature review (n = 89) summarises evidence on HCPs’ perceptions of the risks and benefits of vaccination, trust, and perceptions of mandatory vaccination in Europe. HCPs across studies believed that vaccination is important to protect themselves and their patients. However, beliefs that some diseases such as influenza are less risky were reported by some HCPs as a reason for not getting vaccinated. Concerns about both short- and long-term side effects were identified among HCPs in most studies, such as those affecting the immune or neurological system. Mistrust toward health authorities and pharmaceutical industry was reported in some studies. The question of mandatory vaccination revealed mixed opinions, with some favoring self-determination and others viewing vaccination as a duty. This review highlights key factors influencing HCPs’ confidence in vaccination in Europe.

Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE)

The care home staff influenza vaccination rate in England is significantly lower than the 75% World Health Organisation recommendation. This represents a substantial potential for resident harm. Barriers to staff vaccination stem from individual and organisational levels. Existing interventions address some but not all barriers and are not underpinned by behavioural science theory. This study aims to estimate the effectiveness and cost-effectiveness of a theory-informed intervention to improve care home staff vaccination rates compared to routine practice.Set in care homes with both nursing and residential focus, and a range of ownership status, only homes providing long stay care to older people with a staff vaccination rate below 40% are eligible to participate. Participation expressions of interest will be sought using a variety of approaches prior to seeking consent.The primary outcome measure is the proportion of staff vaccinated at 6 months, with secondary outcome measures being proportion vaccinated at 3 months, numbers of staff sick days, general practitioner and nurse visits to care home, care home resident hospitalisations and mortality.Based on the assumptions that the mean cluster (care home) size is 54 staff, a coefficient of variation of 0.48, control vaccination rate is 55%, intervention 75%, intra-cluster correlation coefficient of 0.2 and with 90% power, and 20% attrition, we require 39 care homes per arm.Blocked randomisation will be at the level of care home, stratified by the proportion of non-white care home staff, and implemented by Norwich Clinical Trials Unit.The intervention comprises co-designed information videos and posters, provision of in-house staff vaccination clinics, and incentive scheme and monthly data collection on trial outcomes. Beyond usual practice, the control arm will additionally contribute monthly data.Data will be collected at the start, monthly and at 6 months, and analysis will be blind to allocation. Statistical analysis will use the intention-to-treat principle with the difference in vaccination rates between groups compared using a random effect logistic regression model at the staff-level.This will be the first study to use a theory-informed intervention designed to comprehensively address identified barriers to care home staff influenza vaccination.Trial registration: ISRCTN ISRCTN22729870 . Registered on 24 August 22. Secondary identifiers: R209939, IRAS 316820, CPMS 53812.

Acceptance and hesitancy of parents to vaccinate children against coronavirus disease 2019 in Saudi Arabia

BACKGROUND

Vaccination of masses against coronavirus disease 2019 (COVID-19) is critical to overcome the pandemic and restore normalcy. However, vaccine refusal and hesitancy prevail in many countries. COVID-19 has rapidly spread in Saudi Arabia since 2020. The acceptance rate of COVID-19 vaccines has been investigated in adults aged >18 years in Saudi Arabia. This study aimed to understand the acceptance and hesitancy of parents to vaccinate children aged <12 years against COVID-19 in Saudi Arabia and identify strategies that can encourage their engagement.

METHODS

We used an online cross-sectional survey distributed to parents who lived in all regions of Saudi Arabia to investigate parents' views on the acceptability of a future COVID-19 vaccine for their children aged <12 years. Five hundred parents living in Saudi Arabia completed the survey.

RESULTS

The survey indicated that mothers were more enthusiastic about participating in the study than fathers. The participant aged 37.31 ± 8.52 years. A total of 38.6% of participants refused to vaccinate their children. Additionally, 56% were unsure if the vaccine would cause serious side effects in children. A total of 48.8% of parents believed that the Pfizer vaccine was suitable for children, while 64.5% failed to decide whether to administer vaccines to their children.

CONCLUSION

Vaccine hesitancy remains a major problem worldwide. A lack of scientific evidence on vaccine efficacy, low education level, and reduced level of health education and promotion are the most common factors in parents in Saudi Arabia. However, some participants agreed to receive vaccines only to protect their family members, and due to governmental rules and school mandates. Therefore, vaccine efficacy and safety in children must be clearly communicated to the public. This information would aid in reducing the hesitancy of parents to vaccinate their children against COVID-19.

Knowledge, attitude, and acceptance regarding COVID-19 vaccines in Sudan

Background

COVID-19 is a respiratory disease caused by SARS-CoV-2, a new coronavirus discovered in December 2019 in China. COVID-19 symptoms are similar to those of viral flu but may be more severe, these symptoms can be defended by vaccines, the most distributed 6 candidate vaccines are Pfizer, BioNTech, Moderna, Johnson & Johnson/Janssen AstraZeneca, Sinopharm, Sinovac. In Sudan, the virus has rapidly spread in the country, causing a total of 37,138 confirmed cases with 2,776 deaths till July 21, 2021. We are targeting health workers, medical students, and the general public to assess their behavior regarding COVID-19 vaccines in Sudan, recognize the determinants of their behavior, and identify the factors increasing vaccine acceptance among them.

Methods

We conducted a pretested cross-sectional online survey involving healthcare workers, medical students, and the general population in Sudan in July and August. We collected the data by sending the survey to social media platforms (e.g., Facebook and WhatsApp). The survey was conducted anonymously without identity-related data. We used both convenience sampling and snowball sampling methods as the participants were asked to forward the survey link to their contacts. The sample size was calculated using Slovin's formula and we estimated the sample size to be 400.

Results

Of our 400 participants, 36.8% (n = 147) were males and 63.2% (n = 253) were females, the mean age of the participants was 24.17 ± 8.07. The overall vaccine acceptance rate was 48.2% (n = 193) and "Occupation" was the only sociodemographic domain significantly associated with vaccine acceptance, showing a higher acceptance rate among health care workers (p = 0.009). "Afraid of unknown side effects" was the most commonly reported barrier to vaccination (p = 0.33).

Conclusion

The vaccine acceptance rate is low, and public health authorities and the government in Sudan have a heavy mission for implementing successful vaccination programs with high coverage.

The Vaccine Hesitancy Profiles and Determinants of Seasonal Influenza among Chinese Community Healthcare Workers: A Cross-Sectional Study

This paper is an evaluation of seasonal influenza vaccination hesitancy (IVH) and its determinants among community HCWs in Chongqing, a city in southwest China. Methods: A cross-sectional survey of 1030 community HCWs with direct or indirect patient contact was conducted from July to September 2021 using a self-administered electronic questionnaire. Possible factors for IVH among community HCWs were investigated by multivariable logistic regression to yield adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Overall, 46.2% of community HCWs were vaccinated in the 2020–2021 season, while 65.8% of community HCWs had IVH. “Don’t know the coverage in China” (OR: 1.46, 95% CI: 1.01–2.11; 40-year-old group OR: 3.02, 95% CI: 1.92–4.76), “complacency” (OR: 4.55, 95% CI: 3.14–6.60) were positively related with having IVH. The community HCWs that had a history of influenza vaccination (OR: 0.67 95% CI: 0.48–0.95) and groups with confidence and convenience (OR: 0.08, 95% CI: 0.06–0.12; OR: 0.34, 95% CI: 0.23–0.52, respectively) were more likely to completely accept vaccination. Conclusions: Measures such as improving the awareness and knowledge of influenza and vaccination and expanding the free vaccination policy, combined with improving the convenience of the vaccination service, will promote increased seasonal influenza vaccination-coverage in community HCWs in Chongqing.

Prevalence of COVID-19 vaccine hesitancy in students: A global systematic review

Background: Examining the prevalence of coronavirus disease (COVID-19) vaccine hesitancy and understanding what motivates students to accept or reject a newly promoted vaccine has the potential in preventing rapid spread of infection and optimizing country-wide mass vaccination programs. This systematic review aimed to examine global COVID-19 vaccine hesitancy among students, and to identify an up-to-date and concise assessment of most common factors influencing vaccine acceptance and hesitancy around the world. Methods: A systematic search of peer-reviewed literatures indexed in reputable databases was performed. After obtaining the results via screening using PRISMA flow diagram, a total of 35 articles met the inclusion criteria and formed the basic structure of the study objectives. Results: The results revealed that, the worldwide pooled COVID-19 vaccine hesitancy rate was (x̅%)=29.8% (95% CI 23.37-36.23) among students. According to the country count assessment, the pooled vaccine hesitancy has been found to be ups and downs across the countries around the world such as  (x̅%)=32% (95% CI 20.04-43.97) in Asia, (x̅%)=(28.11%, 95% CI 18.83-37.40) in the United States, (x̅%)=15.59% (95% CI 8.23-22.95) in Europe, (x̅%)=55.93% (95% CI 40.31-71.55) in Africa, (x̅%)=20.4% in North America, and (x̅%)=22.5% in multi-ethnic areas in the reported student's COVID-19 vaccine hesitancy. In total, 10 key factors were identified. "Side effect" 45.41% (95% CI 29.68-61.14), "safety" 42.27% (95% CI 27.50-57.04), and "trust" 44.95%, (95% CI 26.51-63.39) were the overarching concerns in making student's vaccination decisions. Conclusions: The prevalence of COVID-19 vaccine hesitancy varied among the students; however, vaccine acceptance or refusal relies on several socio-psychological, societal, and vaccine related factors. This study helps the vaccine policy-makers and health stakeholders gain a better understanding of COVID-19 vaccination drive and design the vaccine promotion strategies. Health educational interventions could be the most preferred approach to improve student's adherence and knowledge about the COVID-19 vaccination consequences.

Predictors of healthcare workers' intention to vaccinate against COVID-19: A cross sectional study from Saudi Arabia

BACKGROUND

Vaccination is considered the best way to prevent the spread of COVID-19 and to prevent the complications of the disease. Nevertheless, no awareness campaigns were conducted in Saudi Arabia until March 1, 2021, when the Vaxzevria, or ChAdOx1 nCoV-19 (AZD1222), vaccine became available.

OBJECTIVES

This study aims to determine the factors that can predict healthcare workers' acceptance of the COVID-19 vaccine.

METHODS

A cross-sectional study was conducted from July to September 2021, in our university tertiary hospital (King Saud University Medical City [KSUMC]), Riyadh, Saudi Arabia. The study targeted potential participants among healthcare workers at KSUMC. We assessed healthcare workers' perceptions and beliefs about the COVID-19 vaccine via a questionnaire that was distributed via social media applications such as WhatsApp, Twitter, and Google. Participants were informed about the questionnaire before they filled it out, and they were asked to respond to three screening questions before beginning the main questionnaire. These screening questions ensured that the participants met the inclusion criteria. Included participants were over the age of 18, agreed to answer the questions, and were residents of Saudi Arabia. The participants filled out the self-administered questionnaire.

RESULTS

A total of 529 participants completed the questionnaires. All participants were vaccinated, 68% were female, 55% were married, 35% had been working for less than five years, and 65% had a bachelor's degree. More than half of participants had not previously been infected with COVID-19, and most did not interact with COVID-19 patients. More convenient access to the vaccine increased the odds ratio of participant vaccination by 0.39. An increase in the number of vaccinated friends and family members increased the odds ratio of participant vaccination by 0.30. However, COVID- 19 vaccination mandates decreased the odds ratio of participant vaccination by 0.27. The fitted linear regression model explained 32% of the variation observed in the dependent variable, acceptance of the COVID-19 vaccine, and the adjusted R squared was 0.32. The fitted regression model was statistically significant at a 95% confidence interval; the p-value was 0.00001.

CONCLUSION

In Saudi Arabia, there is an immense need to increase uptake of the COVID-19 vaccine. This requires encouraging more positive beliefs and attitudes regarding vaccination in general and the COVID-19 vaccine in particular.

Knowledge and Attitudes of Medical Students toward COVID-19 Vaccine in Saudi Arabia

Medical students are the future caregivers of communities, and therefore it is important to rectify their misconceptions about the COVID-19 vaccine. We aimed to explore the knowledge and attitudes among medical students toward the COVID-19 vaccine in Saudi Arabia and to compare the level of knowledge between preclinical and clinical years. This epidemiological cross-sectional study of 1445 (47.3% were pre-clinical and 52.7% were clinical year) medical students was conducted at various universities in Saudi Arabia using a simple random sampling technique. The results revealed that 34.3% students did not know how the Pfizer vaccine worked, with a high proportion in preclinical students (69.4%). Almost 37% of participants thought that one could become infected with COVID-19 via the COVID-19 vaccine, and 67.1% of these students were pre-clinical. About 22.6% of students did not trust COVID-19 vaccine information from the health ministry, and the majority of them (79.8%) were pre-clinical. Vaccine hesitancy was shown by about 33.3% (n = 481) of subjects, and surprisingly, almost half of them (48.6%) thought that the COVID-19 vaccine involved conspiracy; the majority of them were pre-clinical (97.9%). The overall response of students indicates a significantly lower level of knowledge and increased negative attitudes of preclinical students toward the COVID-19 vaccine. However, the vast majority of students agreed on the importance of the COVID-19 vaccine to decrease the spread of the disease.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Covid-19 vaccine acceptance and associated factors among pregnant women in Pennsylvania 2020

Data on factors associated with vaccine acceptance among pregnant women are critical to the rapid scale up of interventions to improve vaccine uptake. When COVID-19 vaccines were still in the testing phases of research, we surveyed pregnant women accessing prenatal care at an academic medical institution in Central Pennsylvania, United States to examine factors associated with vaccine acceptance. Willingness to receive a COVID-19 vaccine once a vaccine became available was asked as part of an ongoing study on the COVID-19 pandemic and pregnancy (n = 196). Overall, 65% of women reported they would be willing or somewhat willing to receive the COVID-19 vaccine. Women who had received an influenza vaccine within the past year were more likely to be willing to receive the COVID-19 vaccine than women who had never received an influenza vaccine or those who received it over one year ago (aOR 4.82; 95% CI 2.17, 10.72). Similarly, women who were employed full-time were more willing to receive the COVID-19 vaccine than women who were not employed full time (aOR 2.22; 95% CI 1.02, 4.81), and women who reported feeling overloaded were more willing to receive the COVID-19 vaccine than women who did not feel overloaded (aOR 2.18; 95% CI 1.02, 4.68). Our findings support the need to increase vaccination education among pregnant women before vaccines are rolled out, especially those who have not received an influenza vaccine within the past year. Improved understanding of willingness to vaccinate among pregnant women will improve future pandemic responses and current vaccination efforts.

Comparison of Predictors of COVID-19 Vaccination Intention Between Healthcare Workers and Non-Healthcare Workers in China

Background

Vaccination is an effective strategy to mitigate the spread of COVID-19. This study aimed to compare predictors of vaccination intention between healthcare workers (HCWs) and non-healthcare workers (non-HCWs) in China.

Methods

A web-based cross-sectional survey was conducted among HCWs and non-HCWs. Several bivariate analysis techniques, eg, crosstab with Chi-square, independent t-test and single factor ANOVA, were performed to analyze the correlation. After that, a series of multivariate binary regressions were employed to determine predictors of vaccination intention.

Results

Intention was closely and significantly related with gender, perceived vaccination knowledge, perceived importance and effectiveness of vaccine to prevent COVID-19. HCWs and non-HCWs were heterogeneous, since vaccination intention, perceived knowledge, and attitudes (eg, importance, severity, risk) toward COVID-19 or vaccine had statistically significant difference between the two groups. With comparison of predictors of vaccination intention, for HCWs, demographic factors were the major predictors of COVID-19 vaccination intention. Female HCWs and HCWs with a Master’s or higher degree were more hesitant about vaccination (P = 0.01 and P < 0.001, respectively), while HCWs had greater vaccination intention as their age increased (P = 0.02). For non-HCWs, perceived vaccination knowledge was the major predictor of COVID-19 vaccination intention (P < 0.001). Additionally, perceived importance and effectiveness of vaccine were predictors for both HCWs and non-HCWs.

Conclusion

Vaccination intention of HCWs was greater than that of non-HCWs in China. Measures should be taken to improve the vaccination rate based on the predictors of vaccination intention identified in this study. For HCWs, especially those with a high level of education or who were females, the safety and effectiveness of vaccines in use may reinforce their vaccination intention. For non-HCWs, popularization of general medical knowledge, including of vaccine-preventable diseases, may increase their vaccination intention.

Knowledge, beliefs, and acceptability of people toward new COVID-19 vaccines: a pilot study

A cross-section pilot study was done to determine the knowledge and belief toward new COVID-19 vaccines among a small sample size group of people. A new Vaccine Acceptability Questionnaire (VAQ) consists of 31 questions that were concerned about three elements: underlying factors, knowledge, and beliefs. The study included 96 people from the different regions of Saudi Arabia who had accepted to participate in this pilot study. Around 31% of the included people had low to very low acceptability toward COVID-19 vaccines; however, the other 69% had moderate to high acceptability. The new simple designed questionnaire (VAQ) could be effective in assessing knowledge, beliefs, and acceptability toward COVID-19 vaccination among a specific group of population.

Increasing COVID-19 vaccine acceptance among the general population while maintaining autonomy

The accelerated dissemination of coronavirus disease, its effects on the general public and healthcare system have been unparalleled. COVID-19 vaccination is critical for reducing the alarming incidence of the infection, promoting herd immunity, preventing associated mortality and morbidity, and maintaining public health and safety. Through the development of COVID-19 vaccines, many people are keen to protect themselves against the virus; however, the willingness for vaccination especially in Africa, is far below what is required to stop the ongoing COVID-19 pandemic. As a result, there is an immediate need to implement plans aimed at increasing population vaccine willingness. The slippery slope is whether sanctions, bans and restriction should be imposed on hesitant persons, since transmission of the epidemic can be prevented through stringent enforcement of the control barriers, while eradicating the disease would necessitate vaccination. This commentary provides recommendations about how to increase population vaccine acceptance while maintaining autonomy.

Attitudes, beliefs and practice of Egyptian healthcare workers towards seasonal influenza vaccination

BACKGROUND

Seasonal influenza vaccination is highly recommended for healthcare workers (HCWs) every year to protect them and reduce the risk of disease transmission at workplaces. Relatively few studies addressed influenza vaccination in the Eastern Mediterranean Region.

OBJECTIVES

The main objective of this study was to explore the attitudes, beliefs and practice of Egyptian HCWs towards seasonal influenza vaccine.

METHODS

This is a nationwide cross-sectional study. Data were collected through self-administered structured questionnaire. A sample of 3534 HCWs (physicians and nurses) was collected from different levels of healthcare facilities.

RESULTS

The proportion of seasonal influenza vaccine uptake during the last season was 30.7% while the percentage of ever vaccinated was 46.8%. The most identified reason for non-compliance was lack of trust about vaccine efficacy and its adverse events. Around 80% of participants expressed positive attitude towards influenza vaccine and the vast majority (98%) agreed to uptake the vaccine during pandemic. There was significant positive association between attitude score and influenza vaccine uptake. Raising awareness about vaccine and ensuring vaccine availability were the main suggestions by HCWs to improve vaccine uptake.

CONCLUSIONS

Although there was positive attitude towards influenza vaccine, yet vaccination coverage was suboptimal particularly among those working in university hospitals. Educational messages and operational strategies addressing motivators and barriers that emerged from this study are needed to optimize vaccine uptake.

Determinants of Vaccine Acceptance against COVID-19 in China: Perspectives on Knowledge and DrVac-COVID19S Scale

Background: This study determined the knowledge and attitudes regarding COVID-19 and assessed the acceptance of the COVID-19 vaccine among the Chinese population. Methods: An online and offline cross-sectional study was conducted from 1 to 18 June 2021 among the Chinese population. Demographic characteristics, attitudes, knowledge, values, impact, and autonomy regarding the COVID-19 vaccine were collected using questionnaire. The variables in our study were analyzed by Mann-Whitney test and chi-square test. Results: A total of 93.8% participants were willing to be vaccinated, 2.7% refused, and 3.5% hesitated. In regards to knowledge about the COVID-19 vaccine, 94.3% citizens surveyed knew about the spread of droplets and 65% had knowledge about surfaces touched by an infected person. In addition, 93.8% of participants had knowledge of the common symptoms related to COVID-19, such as fever and cough (93.8%), shortness of breath/anorexia/fatigue/nausea/vomiting/diarrhea (80.2%), and panic and chest tightness (69.4%). Most participants had a strong self-prevention awareness, such as washing hands regularly (92.1%) and wearing a facemask (94.1%). Besides, over ninety percent of respondents would report exposure to SARS-CoV-2 (96.6%) and exposure to symptoms possibility related to COVID-19 (92.9%). If necessary, most respondents would agree to isolate at home (93.5%) or an isolation in hospital (96.3%). Knowledge of COVID-19, including transmission, symptoms, protective measures, and vaccines itself, is associated with vaccination attitude. Values, perceived impacts, knowledge, and autonomy, assessed by the scale of DrVac-COVID19S, have also been revealed as important determinants to vaccine acceptance. Conclusions: Almost 93% of Chinese people surveyed in this study showed a willing attitude toward COVID-19 vaccination. Based on the above results, government and social workers can take measures from these perspectives to improve the vaccination attitude, so as to increase vaccine immunization rates.

Covid-19 vaccine, acceptance, and concern of safety from public perspective in the state of Odisha, India

Introduction: No medication or therapies were found to be effective in controlling the covid-19 pandemic. The fast-track development of covid-19 vaccine brought some hope among health practitioners globally. The major challenge seems to be safety, efficacy, and acceptance of the vaccine. A cross-sectional survey was conducted among the community of the state of Odisha, India, to find out the concerns of safety and acceptance for the vaccine.Methods: A self-administered multiple-choice questionnaire containing 23 items with three sections was prepared in Google form and deployed following snow ball sampling method. The participants recruited were above 18 years of age residing in Odisha. The participation in the survey was completely voluntary. The survey was conducted during February 2021.Results and discussion: In total, 359 members participated in the survey. Majority of the respondent strongly agree/agree that covid-19 vaccine is safe for adults and children. Significant variation among all the groups was found regarding acquisition of higher immunity following infection rather by vaccination, effectiveness in infection prevention, safety in children, provision of mandatory vaccination by government, and public health protection following government guidelines.Conclusion: The major barrier to the covid-19 vaccination was found to be safety and awareness. But there is well acceptance to covid-19 vaccine among the community of Odisha, India, and further efforts to create awareness concerning safety and vaccination will be instrumental in the eradication of this infection.

COVID-19 vaccine hesitancy and willingness to pay: Emergent factors from a cross-sectional study in Nigeria

Introduction

Prior to the COVID-19 pandemic, it took at least several years to develop vaccines for prevention of infectious diseases. The COVID-19 vaccine is the first to be developed within a period of one year. The expediency associated with the development of the COVID-19 vaccine has however been hampered by vaccine hesitancy and other relevant factors that could influence consequent immunisation. This study aimed at investigating factors associated with vaccine hesitancy and willingness to pay for COVID-19 vaccination.

Methods

A cross-sectional approach was used to undertake online and physical data collection with a validated questionnaire.

Results

A total of 1767 valid responses were received, female participants were in the minority (42.2%), majority (54.9%) of the study participants were between the ages of 18 and 30 years, and more than half (53.8%) of the participants were educated up to first degree level. Slightly above half (52.9%) of the study participants indicated that they were worried about side effects that may be associated with COVID-19 vaccines, and this may likely prevent them from taking the vaccine. A strong majority (85.1%) of the study participants indicated that COVID-19 vaccine should be administered at no cost to citizens. Only a quarter (26%) of the participants were willing to pay a fee for COVID-19 vaccination. Also, older participants and those that had been previously infected with COVID-19 were more likely to pay for COVID-19 vaccination.

Conclusion

This study provides critical insights which could influence immunisation efforts during the pandemic. An early understanding of population perceptions of the COVID-19 vaccine can be invaluable in designing successful campaigns. This is even more critical, given supply limitations, access issues and vaccines' inequity occasioned by the international scramble.

Predictors of COVID-19 Vaccine Intention among the Saudi Arabian Population: A Cross-Sectional Survey

The long-term solution to managing the current COVID-19 pandemic is through mass immunization of the population. However, uncertainty or unwillingness to receive the vaccine could be a barrier in attaining sufficient vaccine coverage. Therefore, understanding the psychology of the population towards the vaccines against COVID-19 is of paramount importance. Our study was aimed at determining the predictors of COVID-19 vaccine intention in the Saudi Arabian population. A structured questionnaire guided by the 'Report of the SAGE working group on vaccine hesitancy' was administered during a span of two months among the general population from all administrative regions of Saudi Arabia, proceeding the launch of the vaccination campaign. In total, 879 out of 1600 subjects responded and completed the survey (response rate 54.9%). About 56 percent of the participants intended to be vaccinated. The predictors of a higher intention to vaccinate included those 50 years of age or older, male subjects, people suffering from systemic disease/s, subjects who were not previously infected with COVID-19, those who follow the updates about COVID-19 vaccines, and adults with a higher level of anxiety about contracting coronavirus (p < 0.05). Results from our study and other similar studies can aid policy makers and stakeholders in planning effective strategies based on the changing behavior of the population.

Should nurses take a COVID-19 vaccine?

The issue as to whether health care professionals have a moral obligation to take a vaccine for a communicable disease is not new. Nonetheless, this issue takes on a fresh urgency within nursing practice in the context of the present COVID-19 pandemic, i.e., is there an ethical requirement for nurses to take a COVID-19 vaccine? This paper approaches the issue by using a hypothetical example of Nurse X who has inadvertently infected Patient Y. French's (1984a) Principle of Responsive Adjustment is adapted to claim that there would be a moral expectation that Nurse X takes a COVID-19 vaccine (unless there are justifiable reasons not to). The proposition is also made that, should Nurse X not take a COVID-19 vaccine, they could be morally associated with originally infecting Patient Y.

Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia

BACKGROUND

Developing a vaccine against COVID-19 is considered a key strategy to end the pandemic. However, public acceptance is reliant on beliefs and perception toward the vaccine. Therefore, the study aimed to assess the beliefs and barriers associated with COVID-19 vaccination among the Saudi population.

METHODS

An online self-administered questionnaire was distributed across the main regions of Saudi Arabia on May 2020. The questionnaire addressed the socio-demographic variables, beliefs toward COVID-19 vaccination, and potential barriers that may prevent participants from being vaccinated. The association between COVID-19 vaccine acceptance and sociodemographic variables were analyzed. Logistic regression analysis was used to identify the predicting variables of vaccine acceptance.

RESULTS

Out of 3101 participants, 44.7% were accepting of COVID-19 vaccination if available, whereas 55.3% admitted hesitancy. Younger, male, who received seasonal influenza vaccine were more likely to accept taking the vaccine. The study found that concerns about side effects were the key barrier for vaccine acceptance. Furthermore, the majority of refusers may accept the vaccine if additional studies confirmed safety and effectiveness.

CONCLUSION

Results can be utilized in planning vaccination campaigns while waiting for vaccine development.

Determinants of COVID-19 vaccine acceptance in the Arab world: a cross-sectional study

BACKGROUND

The Arab region is highly affected by the COVID-19 pandemic. Local governments have already started to act against the disease. However, only a few countries provided COVID-19 vaccination. Compliance with vaccination is a major topic affecting proper coverage. Thus, we aim to explore vaccine acceptance among Arab populations, and compare it with the global numbers.

METHODS

An internet-based survey using social media platforms was conducted, targeting adults who were able to read and understand Arabic, had access to the internet, and from all 22 Arab league countries. Due to the response rate variation between participants, the countries were grouped into four categories based on their income: Low income, Lower-middle income, Upper-middle income, and High-income economies. Data about demographics, previous COVID-19 infection, and vaccine acceptance tendency were collected and analyzed using Chi-squared (χ2) test and Logistic regression.

RESULTS

A total of 870 participants completed the survey. 59.3% of the participants were male, 53.3% were between 25 and 44 years, and 69.9% were Arabs who live inside of their home country. The COVID-19 vaccine acceptance rate was 62.4%. A significant higher tendency toward vaccination was identified in males (65.4%, P = 0.04) and people living outside their home countries (67.9%, P = 0.02). However, age group, level of education, and previous COVID-19 infection were all factors with insignificant effect. Citizens of High-income countries were more likely to accept the vaccine (70.2%).

CONCLUSIONS

Less than two-thirds of Arabs are compliant with COVID-19 vaccination. This proportion is relatively lower than the global rate. It is important to develop strategies to promote vaccine acceptance and reach the ideal coverage needed to achieve efficient immunization.

Acceptability of a COVID-19 Vaccine among the Saudi Population

To investigate the associated factors underlying vaccination intentions for Coronavirus Disease 2019 (COVID-19), an online cross-sectional survey was conducted among adults 18 years or over in the Kingdom of Saudi Arabia. Data were collected between 8 and 14 December 2020. A logistic regression analysis was employed to examine and identify the variables associated with vaccination intentions for COVID-19, with the odds ratio (OR) and 95% confidence interval (CI) also calculated. A total of 2137 respondents completed the questionnaire. Overall, about 48% of Saudi adults were willing to receive the COVID-19 vaccine. Participants had stronger intentions to receive a vaccination if they resided in the southern region (OR: 1.95; 95% CI: 1.21-3.14), received the seasonal influenza vaccination in the past (OR: 1.52; 95% CI: 1.17-1.97), believed in mandatory COVID-19 vaccination (OR: 45.07; 95% CI: 31.91-63.65), or reported high levels of concern about contracting COVID-19 (OR: 1.91; 95% CI: 1.29-2.81). Participants were less likely to have an intention to be vaccinated if they had a history of vaccine refusal (OR: 0.28; 95% CI: 0.19-0.40). The low acceptance rate among the Saudi population should be targeted with multifaceted interventions aimed at raising awareness and emphasizing the safety and efficacy of the COVID-19 vaccine.

Healthcare Workers' (HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis

Influenza is a disease responsible for thousands of deaths every year. Although healthcare workers (HCWs) represent a way of contagion for patients, vaccination coverage among them is low. Mandatory vaccination has been proposed, but controversies remain. This systematic review and meta-analysis aimed to assess the acceptance of mandatory vaccination by HCWs, and to investigate associated characteristics. MEDLINE, Scopus, Embase, PsycInfo, CINAHL and Web of Science were used to search for studies assessing the topic. PRISMA statements were followed. Of the 13,457 univocal records found, 52 studies were included in the systematic review and 40 in the meta-analysis. The pooled proportion of HCWs accepting the policy was of 61% (95% CI: 53%- 68%) but with great heterogeneity between continents (from 54% in Europe to 69% in Asia) and in different professionals (from 40% in nurses to 80% in students). Vaccinated HCWs agreed more frequently with mandatory vaccination than non-vaccinated ones. More studies that consider mandatory vaccination acceptance as the main outcome are needed, but the results of this study confirm that in some settings the majority of HCWs favour mandatory vaccination. This, combined with effects that a flu epidemic could have if overlapped to pandemics with similar symptoms, requires renewed considerations on mandatory vaccination.

Determinants of COVID-19 Vaccine Acceptance in Saudi Arabia: A Web-Based National Survey

BACKGROUND

Vaccine hesitancy is a potential threat to global public health. Since there is an unprecedented global effort to develop a vaccine against the COVID-19 pandemic, much less is known about its acceptance in the community. Understanding key determinants that influence the preferences and demands of a future vaccine by the community may help to develop strategies for improving the global vaccination program. The aim of this study was to assess the prevalence of the acceptance of COVID-19 vaccine and their determinants among people in Saudi Arabia.

METHODS

A web-based, cross-sectional study was conducted using snowball sampling strategy under a highly restricted environment. A bilingual, self-administered anonymous questionnaire was designed and sent to the study participants through social media plat-forms and email. Study participants were recruited across the country, including the four major cities (Riyadh, Dammam, Jeddah, and Abha) in Saudi Arabia. Key determinants that predict vaccine acceptance among respondents were modelled using logistic regression analysis. Of the 1000 survey invitees, 992 responded to the survey.

RESULTS

Of the 992 respondents, 642 showed interest to accept the COVID-19 vaccine if it is available. Willingness to accept the future COVID-19 vaccine is relatively high among older age groups, being married participants with education level postgraduate degree or higher (68.8%), non-Saudi (69.1%), employed in government sector (68.9%). In multivariate model, respondents who were above 45 years (aOR: 2.15; 95% CI: 1.08-3.21) and married (aOR: 1.79; 95% CI: 1.28-2.50) were significantly associated with vaccine acceptance (p < 0.05).

CONCLUSION

Addressing sociodemographic determinants relating to the COVID-19 vaccination may help to increase uptake of the global vaccination program to tackle future pandemics. Targeted health education interventions are needed to increase the uptake of the future COVID-19 vaccine.