Development and validation of a COVID-19 vaccine hesitancy scale for adults in the United States

Understanding the determinants of acceptance of COVID-19 vaccines: a challenge in a fast-moving situation

The COVID-19 pandemic, which started in 2019, affected social, economic and political structures all over the world and pushed states to take quick and dramatic measures. Vaccine development studies, which are seen as the most effective way of combating such pandemics, started rapidly and mass vaccinations were started in a short time. However, the opposition to vaccines, which has been going on since the first days of the use of vaccines in the world, has come to the fore again against COVID-19 vaccine programs. Anti-vaccine rhetoric has slowed the pace of the fight against the pandemic. Field studies have shown that more than 50% of people experience hesitations about vaccination. The World Health Organization defines vaccine refusal or vaccine hesitancy as a global threat. Identifying the reasons for vaccine hesitancy is very important in terms of maintaining general public health. For this reason, social scientists are working on the causes of vaccine hesitancy. In the literature, religiosity and low level of education are shown among the reasons for vaccine hesitancy. However, when studies are examined, there are clues that a certain type of religiosity rather than religiosity is related to anti-vaccination. The main problem of this research is whether religiosity and education level predict COVID-19 vaccine hesitancy. In this study, the relationship between religiosity, dogmatic religiosity, education level, socio-economic level and COVID-19 awareness with vaccine hesitancy and their predictive levels are examined. The research is in correlational model and cross-sectional design. The relationship of five variables (religiosity, dogmatic religiosity, education level, socio-economic level, COVID-19 awareness) with vaccine hesitancy and their predictive levels were examined. The sample of the research consists of Muslim Turks over the age of 18. Participants were recruited using the convenience sampling method. The prepared online survey form was shared on social media platforms and the participants were reached. 322 Muslims between the ages of 18-70 (mean 30, SD=10.62) participated in the study. 65% of the participants are women and 55% are single. Ok Religious Attitude Scale, Dogmatic Religiosity Scale, Personal Information Form, COVID-19 Awareness Scale and Vaccine Hesitancy Scale were used as measures. Research findings showed that one-fifth of the participants did not receive the COVID-19 vaccine, half of them had 2 doses and the rest had different doses. Among the unvaccinated, the proportion of women and married people is higher. A negative correlation was found between age and vaccine hesitancy. While no relation could be found between education level and vaccination hesitancy, socio-economic level and vaccination hesitancy showed a negative correlation. When looking at other variables, it was found that there was no relationship between religiosity and vaccine hesitancy, but a negative relationship between COVID-19 awareness and vaccine hesitancy, and a positive relationship between religious dogmatism and vaccine hesitancy. Multiple regression analysis was performed to determine the predictive levels. In the multiple regression analysis, dogmatic religiosity, COVID-19 awareness and socio-economic level were added as a predictor, and vaccine hesitancy as an output variable. In the first step, only religious dogmatism was included in the model as a predictor. In step 3, three predictors were entered simultaneously. The findings showed that dogmatic religiosity, socio-economic status, and awareness of COVID-19 were significant predictors of vaccine hesitancy. In the first step, dogmatic religiosity alone accounts for about 3% of the variance in vaccine hesitancy. In the second step, dogmatic religiosity and socio-economic status together accounted for about 5% of the variance in vaccine hesitancy. And finally, in the third step, dogmatic religiosity, socio-economic level and awareness of COVID-19 together account for 7% of the variance in vaccine hesitancy. Considering the beta coefficients, it was seen that there was a positive correlation between dogmatic religiosity and vaccine hesitancy, and a negative correlation was found between vaccine hesitancy and socio-economic level and COVID-19 awareness. Considering the standardized regression coefficients, it is seen that the most important variable predicting vaccine hesitancy is dogmatic religiosity.

IntroductionThe Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5–17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status.MethodsA community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 –March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time.ResultsYouth’s pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth’s COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth’s COVID-19 vaccination. Youth’s pandemic disbelief also predicted greater parent’s vaccination hesitancy which, in turn, predicted greater youth’s vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents’ pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy.DiscussionOur study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations.

Social capital (SC) has been documented to effectively reduce the spread of diseases, including COVID-19; however, research pertaining to SC and COVID-19 vaccination in Korea is lacking. This cross-sectional study conducted in the city of Wonju, Gangwon Province, Korea (n = 1,096) examined the differences in COVID-19 vaccine trust and hesitancy considering individual characteristics and investigated the effects of SC on COVID-19 vaccine trust and hesitancy. SC was measured based on 14 items pertaining to social trust, network, and norms. Responses regarding COVID-19 screening history, vaccine trust, and vaccine hesitancy were also assessed. SC scores did not differ between sexes, but differed significantly according to age and household income; thus, adults aged 70-79 years had the highest SC scores, and mean SC score increased significantly with income. COVID-19 vaccine trust differed significantly according to age, average household income, social organization involvement, and SC score. COVID-19 vaccine hesitancy differed significantly with age, SC score, and COVID-19 screening history. In univariate logistic regression, age, average household income, social organization involvement, and SC score were significant predictors of vaccine trust; in multivariable analysis, however, the identified predictors were age and SC. In particular, people with an SC score ≥50 were 2.660 times more likely to trust COVID-19 vaccines than those with lower scores. In multivariable analysis, age and SC were significant predictors of vaccine hesitancy. In particular, people with an SC score ≥50 were 1.400 times more likely not to be hesitant about receiving COVID-19 vaccines than people with lower scores. These results indicate that prioritizing policies to increase SC and trust in the government could boost the COVID-19 vaccination rate.

Pediatric Vaccine Hesitancy and COVID-19

Several COVID-19 vaccines have been developed in unprecedented time by research centers and pharmaceutical companies. This study aimed to determine COVID-19 vaccine acceptance and hesitancy rates and investigated the factors that influence vaccine acceptance and hesitancy. A cross-sectional research was conducted among adults in Saudi Arabia between January and March 2021 to determine willingness to receive a COVID-19 vaccine. A self-administered questionnaire was designed to explore the participants’ COVID-19 vaccine acceptance and hesitancy. Categorical variables are described by frequency and percentage. A cross-tabulation analysis using the chi-squared test was performed to find associations between sociodemographic characteristics and vaccine acceptance and hesitancy. Logistic regression analysis was performed for variables that were found to be significant by the chi-squared test. A descriptive analysis of the 531 participants showed that 61.8% were willing to get the COVID-19 vaccine, while 38.2% were not. COVID-19 vaccine hesitancy was higher among women (44.9%), those 34–49 years of age (47.9%), those who were married (41.9%), employed (39.7%), had lower educational attainment (40%), and urban dwellers (40.8%). The main reason for COVID-19 vaccine acceptance was to protect oneself and others, while concerns about vaccine safety were the main reason for vaccine hesitancy. Statically significant associations were found between vaccine acceptance and age (p = .002) and gender (p = .03). Our study revealed a high prevalence of COVID-19 vaccine hesitancy (38.2%). Several sociodemographic characteristics were related to hesitancy, which may hinder the promotion of vaccine uptake. Public health campaigns is recommended to promote COVID-19 vaccine uptake.

The success of the COVID-19 vaccination programme to achieve herd immunity depends on the proportion of the population inoculated. COVID-19 vaccination hesitancy is a barrier to reaching a sufficient number of people to achieve herd immunity. This study aims to determine the prevalence of COVID-19 vaccine hesitancy and to identify the reasons contributing to vaccine hesitancy using the Theory of Planned Behavior. A cross-sectional online survey was conducted between May 2021 to June 2021. Using exponential non-discriminative snowball sampling, participants were recruited via social media and telecommunication platforms. We used a questionnaire that obtained information on participant socio-demographics, vaccine hesitancy, pseudoscientific practices, conspiracy beliefs, subjective norms, perceived behavioural control, main reasons for not intending to get the COVID-19 vaccine; influential leaders, gatekeepers and anti-or pro-vaccination lobbies; and global vaccine hesitancy. A total of 354 responses (mean age = 32.5 years old ±13.6; 70.3% females) were included for analysis. The prevalence of COVID-19 vaccine hesitancy was 11.6%. COVID-19 vaccine hesitancy was significantly and positively associated with those who agreed with influential leaders, gatekeepers, and anti- or pro-vaccination lobbies (adjusted B coefficient = 1.355, p = 0.014), having a “wait and see” attitude to see if the COVID-19 vaccine is safe (adjusted B coefficient = 0. 822, p <0.001), perceiving that the vaccine will give them COVID-19 (adjusted B coefficient = 0.660, p <0.002), planned to use masks/others precautions instead (adjusted B coefficient = 0.345, p = 0.038) and having higher scores in conspiracy beliefs (adjusted B coefficient = 0.128, p <0.001). Concern about the costs associated with the vaccine (adjusted B coefficient = -0.518, p <0.001), subjective norms (adjusted B coefficient = -0.341, p <0.001), and perceived behavioural control (adjusted B coefficient = -0.202, p = 0.004) were negatively associated with vaccine hesitancy. COVID-19 vaccine hesitancy in Malaysia is low. Several factors were identified as being associated with vaccine hesitancy. Factors associated with vaccine hesitancy would be useful in tailoring specific interventions involving positive messages by influential leaders, which address vaccine misinformation and the wait-and-see attitude which may delay the uptake of COVID-19 vaccines.

BackgroundAlthough 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.ObjectiveThe 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.MethodsThis 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 “疫苗“ (vaccine), selected ”台灣” (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.ResultsThe 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.ConclusionsInvestigating 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.

The objective of this review was to describe and map the evidence on COVID-19 and H1N1 vaccine hesitancy or refusal by physicians, nurses, and pharmacists in North America, the United Kingdom and the European Union, and Australia. Since 2009, we have experienced two pandemics: H1N1 "swine flu" and COVID-19. While severity and transmissibility of these viruses varied, vaccination has been a critical component of bringing both pandemics under control. However, uptake of these vaccines has been affected by vaccine hesitancy and refusal. The vaccination behaviors of health care providers, including physicians, nurses, and pharmacists, are of particular interest as they have been priority populations to receive both H1N1 and COVID-19 vaccinations. Their vaccination views could affect the vaccination decisions of their patients. Studies were eligible for inclusion if they identified reasons for COVID-19 or H1N1 vaccine hesitancy or refusal among physicians, nurses, or pharmacists from the included countries. Published and unpublished literature were eligible for inclusion. Previous reviews were excluded; however, the reference lists of relevant reviews were searched to identify additional studies for inclusion. A search of CINAHL, MEDLINE, PsycINFO, and Academic Search Premier databases was conducted April 28, 2021, to identify English-language literature published from 2009 to 2021. Gray literature and citation screening were also conducted to identify additional relevant literature. Titles, abstracts, and eligible full-text articles were reviewed in duplicate by 2 trained reviewers. Data were extracted in duplicate using a structured extraction tool developed for the review. Conflicts were resolved through discussion or with a third team member. Data were synthesized using narrative and tabular summaries. In total, 83 articles were included in the review. Studies were conducted primarily across the United States, the United Kingdom, and France. The majority of articles (n=70) used cross-sectional designs to examine knowledge, attitudes, and uptake of H1N1 (n=61) or COVID-19 (n=22) vaccines. Physicians, medical students, nurses, and nursing students were common participants in the studies; however, only 8 studies included pharmacists in their sample. Across health care settings, most studies were conducted in urban, academic teaching hospitals, with 1 study conducted in a rural hospital setting. Concerns about vaccine safety, vaccine side effects, and perceived low risk of contracting H1N1 or COVID-19 were the most common reasons for vaccine hesitancy or refusal across both vaccines. With increased interest and attention on vaccines in recent years, intensified by the COVID-19 pandemic, more research that examines vaccine hesitancy or refusal across different health care settings and health care providers is warranted. Future work should aim to utilize more qualitative and mixed methods research designs to capture the personal perspectives of vaccine hesitancy and refusal, and consider collecting data beyond the common urban and academic health care settings identified in this review.

Vaccine Hesitancy Narratives

Background Men who have sex with men (MSM), a population bearing the greatest HIV burden in many countries, may also be vulnerable to COVID-19. COVID-19 vaccines are essential to containing the pandemic. However, vaccine hesitancy may compromise vaccine coverage. We aimed to understand the uptake of COVID-19 vaccine and factors associated with COVID-19 vaccine hesitancy among HIV-infected MSM in mainland China. Methods A cross-sectional online survey among HIV-infected MSM was conducted between 13 and 21 February 2021 in mainland China. Variables including demographics, mental health status, HIV characteristics, and knowledge of and attitudes toward COVID-19 pandemic and COVID-19 vaccine were collected. Chi-square tests and multivariable logistic regression were used to analyze factors associated with COVID-19 vaccine hesitancy. Results A total of 1295 participants were included. The median age was 29.3 years (interquartile range [IQR] 25.2–34.0 years). The uptake of COVID-19 vaccine was 8.7%. Two main reasons for receiving vaccines were “regarded vaccination as self-health protection” (67.3%) and “trust in domestic medical technology” (67.3%). Among participants who did not initiate vaccination, concern about side effects (46.4%) and disclosure of HIV infection (38.6%) were top two reasons, and 47.2% had higher vaccine hesitancy. Men who had with high antiretroviral therapy (ART) adherence (adjusted odds ratio [aOR] 0.53, 95% confidence interval [CI] 0.35–0.80), often (0.26, 0.17–0.40) or sometimes (0.46, 0.31–0.67) paid attention to information about the COVID-19 vaccine, preferred domestic vaccines (0.37, 0.24–0.59), thought the pandemic had moderate (0.58, 0.38–0.90) and moderately severe or severe impact (0.54, 0.38–0.78) on immunity, who were waiting for vaccination programs organized at workplace (0.60, 0.44–0.81) and who were unaware of where to get COVID-19 vaccine (0.61, 0.45–0.82) had lower degree of COVID-19 vaccine hesitancy. Men who were concerned about the efficacy (1.72, 1.16–2.54) and side effects (2.44, 1.78–3.35) had higher degree of COVID-19 vaccine hesitancy. Conclusion COVID-19 vaccine uptake among HIV-infected MSM is still suboptimal. Understanding influencing factors of vaccine hesitancy among this group and making tailored measures to alleviate hesitancy would help improve the coverage of COVID-19 vaccination in this population.

Vax attacks: How conspiracy theory belief undermines vaccine support.

Promoting COVID-19 vaccination through music and drama-Lessons from early phase of the pandemic.

Prior trauma exposure, posttraumatic stress symptoms, and COVID-19 vaccine hesitancy

COVID-19 vaccine hesitancy in adults with multiple sclerosis in the United States: A follow up survey during the initial vaccine rollout in 2021