Future pandemic preparedness: conceptualizing vaccine willingness in drug-using populations during COVID-19 in Southeastern U.S. Cities

This study examines the factors influencing COVID-19 vaccination intentions among Chinese residents over the age of 60, with a focus on the mediating roles of Health Beliefs and Cues to Vaccination Action in the relationship between vaccine knowledge and vaccination intentions. We conducted a cross-sectional online survey involving 1,305 participants from Southwest China. Multiple logistic regression analysis identified potential determinants of vaccination intention, including socioeconomic characteristics, knowledge, health beliefs, and cues to vaccination action. Furthermore, mediation analysis using the causal mediation analysis method explored the mediating effects within the knowledge-to-intention pathway. Vaccination intention and its related factors: among the 1212 elderly people included in the study, 92.9% expressed willingness to receive the COVID-19 vaccine. Main factors influencing their vaccination willingness included Residency (urban vs. rural, OR = 0.47, p < 0.01), Age (75 + vs. others, OR = 0.41, p < 0.05), Marital status (OR = 0.36, p < 0.01), Occupation ( business/service vs. others, OR = 0.33, p < 0.05), Awareness of vaccine effectiveness (OR = 1.23, p < 0.01), Cues to vaccination action (OR = 1.31, p < 0.01) and COVID-19 related knowledge (OR = 1.06, p < 0.01). The analysis revealed two significant mediators—Health Beliefs and Cues to Vaccination Action. These mediators (p<0.05 for both natural indirect effect and natural direct effect) acted along two key pathways: (1) From Knowledge of COVID-19 to Health Beliefs to Vaccination Intention: Natural Direct Effects (NDE) ranged from 0.012 to 0.016, with Natural Indirect Effects (NIE) from 0.001 to 0.003, indicating that mediators accounted for 4% to 18% of the total effect. (2) From Knowledge of COVID-19 to Cues of Vaccination Action to Vaccination Intention: NDE ranged from 0.012 to 0.016 and NIE from 0.002 to 0.003, with mediators accounting for 9% to 20% of the effect. The intention to vaccinate against COVID-19 among older adults varies significantly based on socioeconomic and health belief factors. The study identifies health beliefs and cues to action not only as direct contributors but also as crucial mediators in the pathway from knowledge to vaccination intention among older individuals. These findings can extend our understanding of the impact of sociodemographic factors and health beliefs on the COVID-19 vaccination willingness among older adults.

Human papillomavirus (HPV) infection is a significant global public health threat. HPV vaccination in males is crucial for reducing the risk of related cancers and partner infection. On the basis of the health belief model (HBM), this study delves into the factors influencing the willingness to receive HPV vaccination among male college students in Jinan. Using convenience sampling, a cross-sectional survey of 3,410 male students from six Jinan universities was conducted in December 2024. The structured questionnaires collected data on demographics, HPV knowledge, and health beliefs via SPSS 27.0 with univariate and binary logistic regression analyses. The results revealed that 88.5% of the participants were aware of HPV, with 77.7% willing to vaccinate. Univariate analysis revealed that lower grades, urban household registration, and adequate HPV knowledge were correlated with greater vaccination willingness, whereas average monthly consumption of ≥ 2,500 yuan was negatively correlated. Within the HBM, perceived susceptibility and self-efficacy positively predict vaccination willingness, whereas perceived severity and barriers have inhibitory effects. This study concludes that HPV vaccination intention among male university students in Jinan is influenced by sociodemographic factors, knowledge, and health beliefs. Higher willingness was linked to younger age and urban residence, while higher monthly expenditure correlated with lower intention. Adequate HPV knowledge significantly increased willingness, whereas lacking personal acquaintance with HPV-related disease was a barrier. Within the Health Belief Model, perceived benefits paradoxically associated with reduced intention, potentially due to “health illusion” among young adults.

A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.

Following the January 2025 approval of the first male HPV vaccine in the Chinese mainland, we investigated vaccination willingness and its influencing factors among community-dwelling men. We conducted a cross-sectional study in Beijing, recruiting 480 community-based male residents and 399 men who have sex with men (MSM). Participants completed a questionnaire assessing HPV knowledge and the Health Belief Model (HBM) constructs. Multivariable logistic regression was performed to identify determinants of willingness. We found a high level of vaccination willingness, which was notably higher among MSM (90.73%) than the community-recruited male population (87.29%). Critically, willingness surpassed awareness, indicating significant latent demand despite low overall HPV knowledge. HBM analysis showed that perceived benefits promoted willingness in both groups, while self-efficacy of prevention paradoxically acted as an inhibitor. MSM reported higher perceived susceptibility and benefits, but lower severity, compared to community-recruited men. Determinants diverged significantly: income and sexual behavior were unique drivers for community-recruited men, whereas HPV knowledge and STI self-testing drove willingness in MSM. This study confirms high post-approval vaccination willingness but highlights distinct influencing factors. Findings suggest the need for differentiated strategies: universal approaches should highlight vaccine benefits to convert latent demand, while targeted education for MSM must focus on improving knowledge accuracy.

Seasonal influenza imposes a substantial disease burden, yet the vaccination rate in China remains relatively low. So far, research on vaccination willingness has mainly focused on particular groups, such as children, the elderly, and pregnant women. Limited studies have been carried out on the general adult population, which is vital in disease spread. This study aimed to explore the willingness of adults in Shanghai to be vaccinated against influenza and to identify the factors that effectively drive the willingness among the general adult population. A cross-sectional survey was conducted from July to December 2024 among adults aged 18 years and older in Shanghai, China. Data were collected regarding demographic information, constructs of the Health Belief Model (HBM), knowledge of influenza vaccine, and willingness to receive influenza vaccination. Multivariable logistic regression analyses were performed to examine associations between these variables and willingness to be vaccinated. Structural Equation Modeling (SEM) was employed to quantify direct and indirect pathways linking HBM constructs to vaccination willingness. A total of 1786 participants were enrolled in the study. Of these, 9.6% were unwilling to receive influenza vaccination, 32.8% were uncertain, and 57.6% were willing to be vaccinated. Females (AOR = 1.31, 95%CI: 1.03-1.68) and participants self-reported as being in poor health (General: AOR = 2.01, 95%CI: 1.23-3.30; Unhealthy: AOR = 2.35, 95%CI: 1.42-3.92) were more likely to get vaccinated. In terms of HBM constructs, perceived barriers (direct effects: standardized β = -0.27, p < 0.01) exhibited a significant negative correlation with adults' willingness to receive influenza vaccination. Conversely, cues to action were positively associated with vaccination willingness (total effects: standardized β = 0.70, p < 0.01), with perceived barriers significantly mediating this relationship (standardized indirect effect β = 0.18, p < 0.01). This study revealed that cues to action were significant predictors of adults' willingness to receive influenza vaccination, which not only had direct impacts on the willingness but also exerted indirect effects through the reduction of perceived barriers.

Objective Through the lens of behavioral models such as the Theory of Planned Behavior (TPB) and the Health Belief Model, the present study (1) investigated U.S. university students’ willingness to receive the COVID-19 vaccine and (2) examined predictors (e.g. demographics, past vaccine experience, TPB constructs) of vaccine willingness. Method University students (n = 170) completed a survey assessing demographics, health behaviors, attitudes, perceived severity/susceptibility, norms, and vaccine intentions related to the COVID-19 pandemic. Data were collected from April 2020 through July 2020. Results Overall, 56.5% of participants indicated that they would be willing to receive the COVID-19 vaccine once it is available, 39.4% were unsure of whether they would receive the vaccine, and 4.1% indicated they would not receive the vaccine. Multinomial logistic regression indicated that greater adherence to CDC guidelines (p = .030) and greater perceived pro-vaccine norms (p < .001) predicted greater vaccine willingness. Conclusions Results from this study are consistent with previous literature on vaccine hesitancy, whereby normative beliefs and adherence to CDC guidelines were found to be determinants of vaccine willingness. To reduce transmission of the COVID-19 pandemic, interventions aimed at promoting positive attitudes towards vaccination should aim to incorporate these observed determinants.

Factors related to parental willingness to obtain human papillomavirus (HPV) vaccine for adolescents

(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d’Argento, in the period of August 2020–December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.

Increasing vaccination coverage among older adults is a key post-pandemic public health priority. While seasonal influenza (SIV) and pneumococcal vaccines (PV) are widely available and subsidized in China, uptake remains low. This study explored post-pandemic willingness and determinants of SIV and PV uptake among older adults in Shenzhen. A cross-sectional survey of 1917 adults aged ≥60years was conducted from January to May 2024. Descriptive statistics, chi-square tests, and multivariable logistic regression identified factors associated with willingness to receive future SIV and PV, and perceived pandemic influence, including sociodemographic characteristics, healthcare access, vaccination history, health beliefs, and policy awareness. Willingness to receive SIV and PV was high (77.4% and 73.4%), but actual uptake was much lower (55.1% and 29.2%). Over 70% of respondents reported increased willingness due to the COVID-19 pandemic. For SIV, key predictors included previous uptake (adjusted odds ratio [aOR]=3.92, 95% confidence interval [CI]: 3.00-5.15), concern about influenza (aOR=1.96, 95% CI: 1.52-2.52), awareness of free vaccination policy (aOR=1.90, 95% CI: 1.47-2.47), awareness of life-course vaccination (aOR=1.60, 95% CI: 1.11-2.35), having a family doctor (aOR=1.54, 95% CI: 1.10-2.14), and frequent health check-ups (aOR=1.33, 95% CI: 1.03-1.71). For PV, predictors included concern about pneumonia (aOR=3.83, 95% CI: 3.00-4.90), prior uptake (aOR=3.08, 95% CI: 2.18-4.45), free policy awareness (aOR=2.91, 95% CI: 2.27-3.74), having a family doctor (aOR=1.78, 95% CI: 1.27-2.48), frequent check-ups (aOR=1.62, 95% CI: 1.26-2.07), awareness of life-course vaccination (aOR=1.45, 95% CI: 1.03-2.09), and higher household income (aOR=1.43, 95% CI: 1.06-1.95). Willingness-to-pay remained low; healthcare providers, community channels, and traditional media were the main information sources. While the pandemic increased vaccine willingness and uptake among older adults, an intention-behavior gap persists. Strengthening community-based services, life-course immunization promotion, policy communication, and expanded vaccine subsidies are crucial to sustaining uptake progress among this age group.

Cervical cancer poses a threat to the health of women globally. Adolescent girls are the primary target population for HPV vaccination, and guardians' attitude towards the HPV vaccine plays a significant role in determining the vaccination status among adolescent girls. This study aimed to explore the factors influencing guardians' HPV vaccine acceptance for their girls and provide clues for the development of health intervention strategies. Combining the health belief model as a theoretical framework, a questionnaire-based survey was conducted. A total of 2157 adolescent girls and their guardians were recruited. The multivariable logistic model was applied to explore associated factors. The guardians had a high HPV vaccine acceptance rate (86.7%) for their girls, and they demonstrated a relatively good level of awareness regarding HPV and HPV vaccines. Factors influencing guardians' HPV vaccine acceptance for girls included guardians' education background (OR = 0.57, 95%CI = 0.37-0.87), family income (OR = 1.94, 95%CI = 1.14-3.32), risk of HPV infection (OR = 3.15, 95%CI = 1.40-7.10) or importance of the HPV vaccine for their girls (OR = 6.70, 95%CI = 1.61-27.83), vaccination status surrounding them (OR = 2.03, 95%CI = 1.41-2.92), awareness of negative information about HPV vaccines (OR = 0.59, 95%CI = 0.43-0.82), and recommendations from medical staff (OR = 2.32, 95%CI = 1.65-3.25). Also, guardians preferred to get digital information on vaccines via government or CDC platforms, WeChat platforms, and medical knowledge platforms. Though HPV vaccine willingness was high among Chinese guardians, they preferred to vaccinate their daughters at the age of 17-18 years, later than WHO's recommended optimal age period (9-14 years old), coupled with safety concerns. Future work should be conducted based on these findings to explore digital intervention effects on girls' vaccination compliance.

The dynamic evolution mechanism of public health risk perception and the choice of policy tools in the post-epidemic era: Evidence from China

Despite the elevated COVID-19 risk for older adults with cancer, vaccine hesitancy poses a significant barrier to their immunization. Intriguingly, there is limited research on the prevalence of willingness to receive the second booster dose and associated determinants in older adults with cancer. Our objective was to ascertain the level of awareness about COVID-19 vaccines and to uncover the factors influencing the willingness to receive the second booster among Chinese cancer patients aged 65 years and over. To achieve our objective, we conducted a multicenter cross-sectional study in four tertiary hospitals from four provinces of China. This involved using a Health Belief Model (HBM) based self-administered questionnaire and medical records. Subsequently, we employed multivariable logistic regression to identify factors influencing the second COVID-19 booster vaccine willingness. Our results showed that among 893 eligible participants, 279 (31.24%) were aged 65 years and over, and 614 (68.76%) were younger. Interestingly, the willingness to receive the second COVID-19 booster vaccine was 34.1% (95/279) (OR: 1.043, 95% CI: 0.858, 1.267) in participants aged 65 years and over, which was similar to participants aged under 65 years (34.1% vs. 35.5%, p = 0.673). Furthermore, our findings revealed that a positive attitude toward the booster and recommendations from healthcare providers and family members were positively associated with vaccine willingness. Conversely, perceptions of negative impacts on cancer control and vaccine accessibility regarding the second COVID-19 booster were inversely related to the outcome event (all p < 0.05). Our study concludes with the finding of a low willingness toward the second COVID-19 booster in Chinese cancer patients, particularly in the older adults, a fact which warrants attention. This reluctance raises their risk of infection and potential for severe outcomes. Consequently, we recommend using media and community outreach to dispel misconceptions, promote the booster's benefits, and encourage vaccine discussions with healthcare providers and family members.

Background The widespread hesitancy, delays in acceptance, or outright refusal to receive vaccinations, even when readily available, present a notable global challenge. This is particularly pertinent in the context of COVID-19 vaccine hesitancy, where research shows considerable variability in hesitancy rates worldwide. The primary aim of this study is to investigate COVID-19 vaccine intentions among the Saudi population using behavioral theories as a framework. Methodology A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia from January 2022 to December 2022. An online self-administered survey was distributed via social media to reach the targeted participants. Both men and women aged >18 years were included, while non-Saudi individuals and people who are less than 18 years old were excluded. A total of 1,139 participants were included. Results The study found that about 96% of respondents were willing to receive a COVID-19 vaccination. Analyzing sociodemographic and COVID-19-related factors with vaccine intention showed that those previously diagnosed with COVID-19 were less likely to refuse vaccination (P = 0.015). Univariate analyses revealed significant differences in the health belief model (HBM) and theory of planned behavior (TPB) dimensions between willing and unwilling participants. Willing individuals perceived greater infection severity (P = 0.543), higher vaccination benefits (P < 0.01), fewer barriers (P < 0.01), more cues to action (P < 0.01), and lower infection prevention self-efficacy (P < 0.01) compared to the unwilling group. TPB dimensions also differed, with willing individuals having more favorable vaccine attitudes (P < 0.01) and stronger vaccination social norms (P < 0.01). A multivariate logistic regression indicated that having COVID-19 increased vaccine willingness likelihood (odds ratio [OR] = 2.11, 95% confidence interval [CI] 1.14-3.91). Perceived barriers (OR = 0.61, 95% CI 0.44-0.85), self-efficacy (OR = 1.96, 95% CI 1.16-3.32) from HBM, and favorable vaccine attitudes (OR = 1.55, 95% CI 1.02-2.35) from TPB were significant predictors of vaccine willingness. Conclusions The TPB highlighted the importance of attitudes and perceived norms in vaccination acceptance, suggesting their value in vaccination promotion strategies. However, further research, including prospective and interventional studies drawing from a wider array of psychological theories, is needed to develop effective interventions for promoting vaccination.

The COVID-19 pandemic, particularly the period when safe and protective vaccines became available, presented an excellent opportunity to investigate public preferences regarding how to ration a scarce, life-saving resource. It is important to understand which distributive strategies are preferred but, as this is an inherently normative matter, also to which extent different socio-demographic groups hold different opinions. This study assesses the impact of socio-demographic characteristics on preferences for vaccine prioritization during the early stages of the COVID-19 pandemic at the moment when vaccines were not available yet. A representative sample of 2060 Belgians were asked to rank eight prioritization strategies. Based on the rankings, we clustered the eight strategies into five overarching groups. Then, we estimated the potential impact of respondents' socio-demographic characteristics on their preferences towards these five strategies. The ranking exercise shows that the vulnerability strategy (i.e. chronically ill and elderly) is preferred most often (N=1815) and the market strategy (i.e. individuals who come first or pay the most) by the fewest respondents (N=116). Preferences for vaccine distribution vary among population subgroups. Women, older or retired individuals, residents of Flanders, those with a positive attitude towards vaccination efforts and/or high vaccination willingness, and those who prefer the government or scientists to decide upon prioritization were more likely to prefer a designated priority strategy (i.e. vulnerability strategy, workers strategy or spreaders). Furthermore, younger respondents, residents of Wallonia, and those previously infected by COVID-19 tended to favour a risk-independent prioritization strategy (i.e. lottery or market strategy) more than others. This study validates the appropriateness of the implemented rationing approaches, by supporting a phased approach in which first vulnerables were vaccinated. However, it also demonstrates that different subgroups had substantially different preferences and the population was in disagreement about what constitutes a fair rationing policy for a scarce, potentially lifesaving resource.

Developing countries have been facing difficulties in reaching out to low-income and underserved communities for COVID-19 vaccination coverage. The rapidity of vaccine development caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of interventions involving community engagement by addressing demand and access barriers. We used multi-level mixed effects models to estimate average treatment effects across treatment areas. We found that our interventions increased COVID-19 vaccine willingness in two treatment areas that are furthest from city centers by 7.6% and 6.6% respectively, while vaccine uptake increased in one of the treatment areas by 17.1%, compared to the control area. Our results suggest that personalized information campaigns such as community mobilization help to increase COVID-19 vaccine willingness. Increasing uptake however, requires improving access to the vaccination services. Both information and access may be different for various communities and therefore a "one-size-fits-all" approach may need to be better localized. Such underserved and marginalized communities are better served if vaccination efforts are contextualized.