Changes in COVID-19 Vaccine Hesitancy Among Black and White Individuals in the US

Importance

COVID-19 has disproportionately affected Black individuals in the US; however, vaccination rates among Black individuals trail those among other racial groups. This disparity is often attributed to a high level of vaccine hesitancy among Black individuals, but few studies have examined changes in vaccine hesitancy over time.

Objectives

To compare changes in vaccine hesitancy between Black and White individuals in the US and to examine mechanisms that might help explain the observed differences.

Design, Setting, and Participants

This survey study used 7 waves of data collected using a panel design. A total of 1200 English-speaking adults in the US were recruited from a nonprobability online panel to construct a census-matched sample. Participants were contacted monthly between December 9, 2020, and June 16, 2021.

Main Outcomes and Measures

The main outcome of interest was self-reported vaccination intention, measured on a 6-point scale (where 1 indicates extremely unlikely and 6 indicates extremely likely). Beliefs about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores denoting greater agreement.

Results

The baseline data included 1200 participants (693 women [52.0%; weighted]; 921 White individuals [64.0%; weighted], 107 Black individuals [12.2%; weighted]; weighted mean [SD] age, 49.5 [17.6] years). The survey participation rate was 57.0% (1264 of 2218). Black and White individuals had comparable vaccination intentions in December 2020, but Black individuals experienced larger increases in vaccination intention than White individuals relative to baseline in March 2021 (b = 0.666; P < .001), April 2021 (b = 0.890; P < .001), May 2021 (b = 0.695; P < .001), and June 2021 (b = 0.709; P < .001). The belief that the vaccines are necessary for protection also increased more among Black than White individuals in March 2021 (b = 0.221; P = .01) and April 2021 (b = 0.187; P = .04). Beliefs that the vaccines are safe and effective (b = 0.125; P < .001) and necessary (b = 0.405; P < .001) were positively associated with vaccination intention. There was no evidence that these associations varied by race.

Conclusions and Relevance

This survey study suggests that the intention of Black individuals to be vaccinated was initially comparable to that of White individuals but increased more rapidly. There is some evidence that this increase is associated with changes in beliefs about the vaccine. Vaccination rates continue to be lower among Black individuals than White individuals, but these results suggest that this might be less likely the result of vaccine hesitancy than other factors.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey

INTRODUCTION

Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap.

METHODS AND MATERIALS

This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis.

RESULTS

The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe).

CONCLUSIONS

Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults

Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12th and July 30th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.

Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability

Importance

Several COVID-19 vaccines have been authorized in the US, yet preliminary evidence suggests high levels of vaccine hesitancy and wide racial, ethnic, and socioeconomic disparities in uptake.

Objective

To assess COVID-19 vaccine acceptance among health care personnel (HCP) during the first 4 months of availability in a large academic hospital, compare acceptance with previously measured vaccine hesitancy, and describe racial, ethnic, and socioeconomic disparities in vaccine uptake.

Design, Setting, and Participants

This cross-sectional study included 12 610 HCP who were offered COVID-19 vaccination at a major academic hospital in Philadelphia between December 16, 2020, and April 16, 2021.

Exposures

For each HCP, data were collected on occupational category, age, sex, race and ethnicity (Asian or Pacific Islander, Black or African American [Black], Hispanic, White, and multiracial), and social vulnerability index (SVI) at the zip code of residence.

Main Outcomes and Measures

Vaccine uptake by HCP at the employee vaccination clinic.

Results

The study population included 4173 men (34.8%) and 7814 women (65.2%) (623 without data). A total of 1480 were Asian or Pacific Islander (12.4%); 2563 (21.6%), Black; 452 (3.8%), Hispanic; 7086 (59.6%), White; and 192 (1.6%), multiracial; 717 had no data for race and ethnicity. The mean (SD) age was 40.9 (12.4) years, and 9573 (76.0%) received at least 1 vaccine dose during the first 4 months of vaccine availability. Adjusted for age, sex, job position, and SVI, Black (relative risk [RR], 0.69; 95% CI, 0.66-0.72) and multiracial (RR, 0.80; 95% CI, 0.73-0.89) HCP were less likely to receive vaccine compared with White HCP. When stratified by job position, Black nurses (n = 189; 62.8%), Black HCP with some patient contact (n = 466; 49.9%), and Black HCP with no patient contact (n = 636; 56.3%) all had lower vaccine uptake compared with their White and Asian or Pacific Islander counterparts. Similarly, multiracial HCP with some (n = 26; 52.0%) or no (n = 48; 58.5%) patient contact had lower vaccine uptake. In contrast, Black physicians were just as likely to receive the vaccine as physicians of other racial and ethnic groups.

Conclusions and Relevance

In this cross-sectional study, more than two-thirds of HCP at a large academic hospital in Philadelphia received a COVID-19 vaccine within 4 months of vaccine availability. Although racial, ethnic, and socioeconomic disparities were seen in vaccine uptake, no such disparities were found among physicians. Better understanding of factors driving these disparities may help improve uptake.

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake

The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

Twitter sentiment analysis from Iran about COVID 19 vaccine

BACKGROUND AND AIMS

The development of vaccines against COVID-19 has been a global purpose since the World Health Organization declared the pandemic. People usually use social media, especially Twitter, to transfer knowledge and beliefs on global concerns like COVID-19-vaccination, hence, Twitter is a good source for investigating public opinions. The present study aimed to assess Persian tweets to (1) analyze Iranian people's view toward COVID-19 vaccination. (2) Compare Iranian views toward a homegrown and imported COVID-19-vaccines.

METHODS

First, a total of 803278 Persian tweets were retrieved from Twitter, mentioning COVIran Barekat (the homegrown vaccine), Pfizer/BioNTech, AstraZeneca/Oxford, Moderna, and Sinopharm (imported vaccines) between April 1, 2021 and September 30, 2021. Then, we identified sentiments of retrieved tweets using a deep learning sentiment analysis model based on CNN-LSTM architecture. Finally, we investigated Iranian views toward COVID-19-vaccination.

RESULTS

(1) We found a subtle difference in the number of positive sentiments toward the homegrown and foreign vaccines, and the latter had the dominant positive polarity. (2) The negative sentiment regarding homegrown and imported vaccines seems to be increasing in some months. (3) We also observed no significant differences between the percentage of overall positive and negative opinions toward vaccination amongst Iranian people.

CONCLUSIONS

It is worrisome that the negative sentiment toward homegrown and imported vaccines increases in Iran in some months. Since public healthcare agencies aim to increase the uptake of COVID-19 vaccines to end the pandemic, they can focus on social media such as Twitter to promote positive messaging and decrease opposing views.

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

BACKGROUND

Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada.

METHODS

Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations.

RESULTS

The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information.

DISCUSSION

We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults

PURPOSE

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups.

METHODS

We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake.

FINDINGS

At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination.

CONCLUSIONS

By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.

Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama

Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.

The Impact of a Human Papillomavirus Facebook-Based Intervention (#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy

Background

Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults.

Objective

This study aimed to assess the impact of a Facebook-based intervention (#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years.

Methods

A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (#HPVVaxTalks). #HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis.

Results

Overall, 32 of the 43 (74%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness.

Conclusions

The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities.

Vaccine hesitancy among racially diverse parents in Canada: The important role of health literacy, conspiracy beliefs and racial discrimination

Parental vaccine hesitancy is a global public health issue that leads to lower immunization coverage among children. While vaccine mistrust is increased among racialized adults, whether parental vaccine hesitancy differs by ethnicity in the era of COVID-19 is unknown. Addressing these gaps in the literature, this study explores the factors influencing vaccine hesitancy among a racially diverse and representative sample of Canadian parents of children aged 0 to 12, comparing perspectives across different racial groups. An online survey was administered to a nationally representative sample of Arab, Asian, Black, Indigenous, White, and Mixed-race parents from October to November 2023. Data were collected on demographics, COVID-19 vaccine hesitancy, experience of major racial discrimination, conspiracy beliefs and health literacy. A total of 2528 parents (57.52 % women, 42.29 % men, and 0.20 % identified as non-binary gender) completed the survey. Significant mean differences in vaccine hesitancy were observed among racialized groups, F(7, 2520) = 3.89, p < .001, with Arab parents (M = 23.73, SD = 7.46) reporting higher hesitancy than White parents (M = 21.28, SD = 8.59). Younger participants (14-24 years) showed greater hesitancy (M = 23.98, SD = 8.22) than those aged 55+ (M = 20.26, SD = 7.83), F(4, 2523) = 2.84, p = .023. Regression analyses indicated that conspiracy beliefs (β = 0.48, p < .001) and racial discrimination (β = 0.09, p = .012) are key predictors of vaccine hesitancy. A significant interaction between conspiracy beliefs and discrimination was found among racialized groups (β = 0.24, p < .001). Based on these results, addressing vaccine hesitancy requires nuanced, participatory approaches that foster trust, counter misinformation, and acknowledge systemic racial inequities. As, health literacy, conspiracy beliefs, and racial discrimination significantly shape parental decisions, future policies must integrate culturally and racially tailored strategies to promote vaccination, ensuring that every child in Canada is protected.

Factors Associated with Parents' COVID-19 Vaccination Decisions for Their Children in an Economically Marginalized, Diverse Community

COVID-19 vaccine hesitancy is a significant public health concern, particularly among parents who serve as gatekeepers for their child(ren)'s vaccination status. This study adds to the literature by examining COVID-19 vaccine decisions among parents living in a mid-size, lower-income, racially/ethnically diverse, community. Parents of children, < 18 years and enrolled in the public schools system, were invited to complete a questionnaire offered in English, Spanish, and Portuguese. The questionnaire included questions about their child(ren)'s vaccination status, as well as factors which, based on the literature, might impact parents' vaccination decisions. Parents (n = 277) were mostly Hispanic/Latinx, females, with a high school degree/GED as their highest level of education achieved, a mean age of 40 years, and an average of two children < 18 years. Four-fifths (78.6%) of parents reported being vaccinated against COVID-19, but only 40.8% reported having all of their children vaccinated; 14.8% had some of their children get the COVID-19 vaccine, and 44.4% had none of their children get the COVID-19 vaccine. In bivariate associations, parents' vaccination status, parents age, the CDC website as a COVID-19 information source, awareness of age eligibility for the COVID-19 vaccine, parents reporting knowing someone who does not want to vaccinate their child, and parents' perceived social norm score were associated with children's vaccination status. However, when multivariate analyses were conducted, only parents' age and perceived social norms increased parents' odds of choosing to vaccinate their child. These findings have implications for those promoting COVID-19 vaccination among parents in lower-income, diverse communities.

COVID-19 vaccine acceptance differences among unvaccinated foreign- and united states-born persons: A cross-sectional study, 2021

PURPOSE

To investigate the association between nativity and COVID-19 vaccine acceptance and its interaction with race/ethnicity, education, and English proficiency.

METHODS

Differences in vaccine acceptance among propensity-score matched foreign- and US-born persons using 2021 California Health Interview Survey Data were measured using a survey-weighted multivariable logistic regression model with interaction terms and average predicted probabilities between nativity and: race/ethnicity, education, English proficiency.

RESULTS

A total of 4,234,655 survey-weighted persons (8504 unweighted) met inclusion criteria; 2251,279 (53 %) were foreign-born (1,983,376 US-born), and 55 % of all persons were Hispanic/Latino, 22 % were Non-Hispanic White, 17 % were Non-Hispanic Asian/Pacific Islander, 3.6 % were Non-Hispanic Black/African American, and 2.5 % were categorized as 'Other'. Foreign-born status was significantly associated with greater odds of acceptance (adjusted odds ratio [aOR], 2.81 [95 %CI, 1.16-6.83]). Foreign-born Hispanic persons had a significantly greater probability of acceptance compared to their US-born counterparts (average probability difference, +0.11 [95 %CI, +0.023, +0.20]). Foreign-born persons with poor English proficiency had a lower probability of acceptance versus US-born persons (APD, -0.081, [95 %CI, -0.43, 0.27]).

CONCLUSIONS

Nativity was significantly associated with COVID-19 vaccine acceptance, and this relationship varied by race/ethnicity and English proficiency. These findings may be used to direct future interventions aimed at improving COVID-19 vaccination rates.

Perspectives on vaccination among unvaccinated members of a Canadian indigenous population

From the beginning of the COVID-19 pandemic, the potential impact on Indigenous (First Nations, Métis and Inuit) communities in Canada was a major concern. Evidence from previous pandemics, particularly H1N1, suggested that more cases and poorer outcomes among Indigenous Peoples was likely and that there might be barriers to Indigenous Peoples' vaccination. In this short report we consider the non-vaccination decisions of a sample of unvaccinated Métis Nation of Ontario citizens. A small sample of six Métis individuals who had chosen not to receive the COVID-19 vaccine was recruited using referral and interviewed online. Participants expressed low confidence in COVID-19 vaccines, and cited safety concerns as the primary reason. Low confidence was in government and media was a major concern, and respondents referred to historical treatment of Indigenous peoples as reasons for suspicion. We discuss this continuing mistrust and its implications for future pandemic response.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Exploring vaccination attitudes in African communities in Canada: A mixed-methods study protocol

INTRODUCTION

Vaccine hesitancy is a complex issue influenced by many interacting factors. While literature on its contributing causes continues to expand, there is limited research on the contextual and cultural dynamics that shape vaccine hesitancy among African-born individuals in Canada. Identifying and understanding these factors is critical in developing targeted health interventions that address specific barriers to vaccination within this community. The study aims to explore the unique socio-cultural and context-specific elements of vaccine hesitancy among African community members living in Canada.

METHODS AND ANALYSIS

The study will use a mixed-methods approach to investigate vaccine hesitancy among African community members living in Southwestern Ontario. In the qualitative study, we will conduct semi-structured interviews and participatory focus groups within each of the selected study areas: London, Windsor and Chatham-Kent. The qualitative data will be collected, transcribed and then analyzed thematically using NVivo 12. For the quantitative study, we will provide participants with surveys to accurately assess the predictors of vaccine hesitancy. The quantitative data will be analyzed using logistic regression to explore how socio-cultural influences, trust, and accessible information impact vaccine hesitancy.

DISCUSSION

This study addresses a significant gap in existing literature by providing cultural and contextual insights on the drivers of vaccine hesitancy among African-born individuals. Using a mix-method design, the study offers a rich understanding of the influences shaping vaccine decision-making. The findings will support the development of health policies and interventions aimed at improving overall health outcomes for African communities within Canada.

Health system mistrust, ultra-orthodox Jews in the US, and vaccine hesitancy

A minority of ultra-Orthodox (Charedi) Jews choose not to be vaccinated, and their refusal has assumed significant importance from a variety of perspectives. Clinicians often encounter patients whose beliefs are different from their own. Vaccine hesitancy within the US Charedi Jewish community is a factor contributing to outbreaks of disease, reflecting a growing mistrust between communities and arms of the State played out on the terrain of bodies and societies. Clinicians need to be aware of and understand this broader context as a foundation of empathetic listening and epistemic humility that might lead to improved health for the Charedi community based on reinforced trust.

Predictors affecting vaccine hesitancy towards annual COVID-19 booster shots among populations from different countries

BACKGROUND

Coronavirus Disease-19 (COVID-19) is reported to cause significant mortalities. Vaccination has the probability to reduce the burden of COVID-19. Annual vaccination is better to be established, but vaccine reluctance has been observed among different populations.

OBJECTIVES

To recognize the associated factors and the predictors affecting vaccine hesitancy towards annual COVID-19 vaccine shots among African and Asian populations.

METHOD

A cross-sectional study was conducted on a population from diverse nationalities using a structured, self-administered questionnaire. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using multiple logistic regression to identify predictors of vaccine hesitancy.

RESULTS

A total of 502 participants from four countries: 152 Jordanians (30.3%), 145 Egyptians (28.9%), 103 Ghanaians (20.5%), and 102 Sudanese (20.3%) were included in the study. The majority were females (307, 61.2%). Egyptians show the highest willingness to receive annual COVID-19 vaccine shots (99, 68.3%), while Jordanians (68, 44.7%), Ghanaians (42, 40.8%), and Sudanese (60, 58.8%) exhibit more hesitancy or refusal. Hesitancy is higher among the younger age group (56.5%, P = 0.003) and lower education levels (55.6%, P = 0.008). Higher knowledge (OR = 0.843, p = 0.002), and a positive attitude toward vaccine administration (OR = 0.878, P < 0.001) significantly predict lower hesitancy. The fear of severe side effects (42%) was the most common cause of COVID-19 vaccine hesitancy.

CONCLUSIONS

Young age and low education levels are linked with increased hesitancy toward annual COVID-19 vaccination shots. Higher knowledge, and positive attitude, and previous influenza vaccination predict annual vaccine hesitance. Public health actions in the form of awareness campaigns are needed to promote the importance of COVID-19 booster shots vaccination and address worries about safety, and side effects to efficiently reach the target young and low education group with heighten vaccine service quality on the way to build vaccine assurance and lessen hesitancy.

Effects of Government Mistrust and Group-Based Medical Mistrust on COVID-19 Vaccine Hesitancy Among a Sample of African Americans

BACKGROUND

Despite the demonstrated efficacy of coronavirus disease (COVID-19) vaccines, higher rates of vaccine hesitancy among African Americans remain concerning. As determinants of vaccine hesitancy, the simultaneous roles of government mistrust and group-based medical mistrust have not been examined via from a cognitive information perspective among African Americans.

PURPOSE

We examined the direct and indirect effects of government mistrust and group-based medical mistrust on COVID-19 vaccine hesitancy in a sample of African Americans.

METHODS

We obtained data from 382 African Americans in South-East Michigan via an online survey. We assessed demographic variables, government mistrust, group-based medical mistrust, COVID risk and COVID worry, and positive and negative beliefs regarding the COVID-19 vaccine (i.e., vaccine pros and cons), and vaccine hesitancy. We examined our hypotheses with path analyses.

RESULTS

Results indicated significant direct effects of government mistrust on vaccine hesitancy; however, despite a significant correlation, there was no direct effect of group-based medical mistrust on vaccine hesitancy. The effect of group-based medical mistrust was fully mediated by both vaccine pros and cons, whereas the effect of government mistrust was partially mediated by vaccine pros. COVID risk and COVID worry did not mediate the effects of mistrust to vaccine hesitancy.

CONCLUSION

Negative effects of group-based medical mistrust on COVID-19 vaccine hesitancy among African Americans may be amenable to interventions that focus on beliefs about the vaccine rather than beliefs about vulnerability to the virus. However, given its direct effect, it may be necessary to focus directly on government mistrust to diminish its effects on COVID-19 vaccine hesitancy.

Newness, unfamiliarity, and cultural beliefs; social and behavioural barriers to COVID-19 vaccination among the Dumagat Remontado, an Indigenous population in the Philippines

Indigenous Peoples faced unique challenges that contributed to vaccine hesitancy, including limited healthcare access, mistrust of medical institutions, and adherence to traditional practices. While vaccination played a critical role in improving public health, Indigenous communities often remained underserved and sceptical about its benefits, particularly in the context of COVID-19. Thus, this study aimed to explore the perceptions and experiences of the Dumagat Remontado, an Indigenous Peoples in the Philippines, on COVID-19 vaccination. Through their narratives, the study aimed to identify the factors that affect their intention to get vaccinated and uptake of the COVID-19 vaccine. A qualitative research design was employed, with in-depth interviews conducted with 18 respondents in Rizal, Philippines in January 2023 and the Framework Approach used for data analysis. Findings were presented within the World Health Organization's Behavioural and Social Drivers (BeSD) framework for vaccination. Key factors influencing vaccine intention included government policies, social norms, perceived disease severity, susceptibility, and vaccine benefits and risks. Health experts and vaccinated individuals were identified as the most favoured sources of vaccine information. Accessibility of services, healthcare worker demeanour, and information availability surfaced as practical issues which hindered vaccine uptake. The study underscored the importance of involving the Dumagat Remontado in conceptualising and implementing vaccination programmes, as well as utilising vaccine champions, real-life narratives, and the local language in information dissemination. These contributions emphasised the need for inclusive public health strategies to address vaccine hesitancy among Indigenous Peoples, ultimately promoting equitable access to healthcare and improving vaccination rates.

Mapping Vaccination Mindsets among UK Residents of Black Ethnicities with HIV: Lessons from COVID-19

Vaccine hesitancy is a leading threat to public health, but little is known about the beliefs and mindsets that drive vaccine hesitancy, especially among people of Black ethnicities. This study aimed to understand vaccine related beliefs and their relationship with SARS-CoV-2 vaccine uptake in UK residents of Black ethnicities living with HIV. Adults of self-reported Black ethnicities with HIV were recruited at 12 clinics in England. Participants completed questionnaires in clinic, including an adapted version of the Beliefs about Medicines Questionnaire (BMQ) to assess Necessity and Concerns beliefs about the SARS-CoV-2 vaccine. SARS-CoV-2 vaccination status was ascertained through self-report and shared care records. A total of 863 participants were enrolled between June 2021 and October 2022, most of whom (92%) had received at least one dose of the SARS CoV-2 vaccine. After adjusting for age and region of birth, higher perceived need for the vaccine (OR = 2.39, 95% CI = 1.51-3.81), fewer concerns about the vaccine (OR = 0.16, 95% CI = 0.08-0.30), and weaker endorsement of COVID-19 Conspiracy Beliefs (OR = 0.31, 95% CI = 0.19-0.50) were associated with vaccination uptake. Being born outside sub-Saharan Africa was associated with reduced odds of being vaccinated. This study shows the importance of specific beliefs driving vaccine hesitancy and uptake. Further studies should explore the role of these beliefs and mindsets in influencing uptake of other vaccinations, and to work with key stakeholders to explore how to address vaccine hesitancy and improve vaccine uptake in these and other populations.