Prevalence of vaccine hesitancy in Italy: a cross-sectional study.

Background: Vaccine hesitancy is hesitancy to take vaccine. Studies are required to identify prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy. It is equally important to recognize factors responsible for this hesitancy. This data will help to plan health education measures so that healthcare workers can overcome the barriers for vaccine hesitancy. Objective: The objective of this article is to study prevalence and factors associated with COVID-19 vaccine hesitancy among healthcare workers. Methods: This was a single-center, cross-sectional study carried out over a period of two months among 1063 healthcare workers. Those with missing information, not consenting and absent on the day of survey were excluded. Healthcare workers included doctors including postgraduates, nurses, para-medical staff, admin staff, and housekeeping staff either working in hospital or medical college. Results: Prevalence of vaccine hesitancy was 15.1%. On logistic regression, as age increased odds of vaccine hesitancy decreased significantly (OR = 0.95; 95%CI = 0.92-0.98; P < 0.05). Patient contact of <10/day was associated with the decreased odds of vaccine hesitancy compared to those with patient contact of >40/day. Odds of vaccine hesitancy among those with poor knowledge was 2.84 (95%CI = 1.91-4.21; P < 0.05) times more compared to those with good knowledge. Odds of vaccine hesitancy was 3.22 (95%CI = 1.09-9.48; P < 0.05) times and 3.31 (95%CI = 1.05-10.48; P < 0.05) times more among educated up to primary and illiterate respectively compared to higher educated persons. Conclusion: We conclude that low levels of education, poor knowledge, and young age were independently and significantly associated with vaccine hesitancy among healthcare workers. Prevalence of vaccine hesitancy was still high at 15.1%.

Background. The coronavirus disease 2019 (COVID-19) pandemic highlighted the challenges and impact of vaccine hesitancy and the role of health care institutions in mounting an effective pandemic response. The study objective was to determine the prevalence and predictors of COVID-19 vaccine hesitancy among health care workers in tertiary health care institutions in Nigeria. Methods. A cross-sectional analytical design that used convenience and snowballing techniques to enroll 347 health care workers from tertiary health care institutions in Imo State, Nigeria, from September 28 to October 14, 2021. Data was collected using a structured online questionnaire and bivariate and multivariate analyses were done using SPSS at a level of significance set at p ≤ 0.05 . Result. The prevalence of vaccine hesitancy was 35.4%. HCWs of the Pentecostal faith (aOR: 2.52) and males (aOR: 2.72) were significantly more likely to be COVID-19 vaccine hesitant. About 30% of the respondents reported that they trusted information from the Internet and social media relating to COVID-19 and its vaccine. However, respondents who felt there was enough information about the vaccine and its safety were more than two and a half times more likely to be vaccine-hesitant (aOR: 2.77). About 20% and 31% of the respondents, respectively, stated that the government has an ulterior motive and that they did not trust the vaccine manufacturers. However, respondents who do not trust the government were more than two and a half times more likely to be COVID-19 vaccine hesitant (aOR: 2.69). Conclusion. The issues of vaccine hesitancy among health care workers in a developing country appear to be fundamental and very challenging to resolve. Therefore, the approach of instituting government vaccine uptake mandates for health care workers may be the solution for tackling vaccine hesitancy in health care institutions.

Vaccine hesitancy and refusal were linked to various religious beliefs, including Islam. Regardless, there were limited studies which offer insights into the role of religious affiliations and related misconceptions in childhood vaccination refusal and hesitancy in Islamic and Muslim Majority countries (MMC). Therefore, this review identifies the prevalence of childhood vaccine hesitancy and its contributory factors while determining the role of religious beliefs in childhood vaccine hesitancy in Islamic states and MMC. We examined four electronic databases for published studies related to childhood vaccine hesitancy and refusal in Islamic countries or MMC from 2011 to 2021. Results revealed that the prevalence of vaccine hesitancy and vaccine refusal range from 8.0% to 21.0% and 1.0% to 58%, respectively, which was comparable to other countries. Parental reasons contributing towards vaccine hesitancy and refusal include concerns related to vaccine safety, side effects and effectiveness, preference for alternative measure to prevent disease, prior bad experiences, and healthcare system distrust. Religious reasons instigating vaccine hesitancy include concerns that vaccine consists of haram ingredients, beliefs that vaccine is against God’s will, perceptions of vaccine being harmful, influences from religious leaders, and distrust towards religious authorities supporting vaccination. In brief, various factors induce vaccine hesitancy and refusal in Islamic states and MMC. Further studies could provide better insights into the role of religious factors in childhood vaccine hesitancy within local contexts in order to formulate effective interventions to address this issue.

BACKGROUND:The World Health Organization (WHO) states that vaccine hesitancy is one of the top 10 threats to global public health. Evidence shows that vaccine hesitancy studies in India are limited and targeted toward individual vaccines. The study aimed to fill this gap by exploring the relationship between demographics and SAGE factors toward vaccine hesitancy.MATERIALS AND METHODS:A hospital-based, cross-sectional, analytical study was conducted in a non-governmental organization (NGO) hospital with 330 beds, located in Bathalapalli, Andhra Pradesh, India. Mothers of under-five children who attended outpatient departments of pediatrics or obstetrics and gynecology were included. A total of 574 mothers were enrolled and vaccine hesitancy was determined by reviewing the mother–child protection card for the presence of delay or refusal of the recommended vaccine. A face-to-face interview was conducted to obtain demographics and WHO–SAGE variables from the participants. Binary logistic regression analysis was performed to associate independent variables (demographics and SAGE variables) with the dependent variable (vaccine hesitancy).RESULTS:Out of 574 respondents, 161 mother's children were noted as vaccine-hesitant (refusal = 7; delay = 154); and the prevalence of vaccine hesitancy was 28.05%. The delay was observed in all recommended vaccines, but the refusal or reluctance was seen in only four vaccines (hepatitis B birth dose = 1; IPV 1 and 2 = 2; Measles 1 and 2 = 3; and Rota 1, 2, and 3 = 1). The respondents’ demographics like no or lower parent education (OR = 3.17; 95%CI = 1.50–6.72) and fewer antenatal visits (OR = 2.30; 95%CI = 1.45–3.36) showed higher odds, whereas the upper socioeconomic status showed lower odds (OR = 0.09; 95%CI = 0.02–0.36) toward vaccine hesitancy. The WHO–SAGE dimensions like awareness (OR = 0.14; 95%CI = 0.03–0.53), poor access (OR = 7.76; 95%CI = 3.65–16.51), and low acceptability of the individual (OR = 07.15; 95%CI = 1.87–27.29), community (OR = 6.21; 95%CI = 1.58–24.33) were significantly associated with vaccine hesitancy.CONCLUSION:The study concludes that the prevalence of vaccine hesitancy was high. Vaccine safety and children's health are primary concerns for parents’ refusal/reluctance. To achieve 100% immunization coverage, policymakers need to reduce vaccine hesitancy by developing strategies based on demographic and WHO–SAGE working group predictors.

IntroductionVaccines have long been one of the most effective strategies for public health during epidemics and pandemics caused by infectious diseases. Vaccine hesitancy is a public health problem that hinders the control of disease transmission. It refers to the refusal or reluctance to receive vaccines for various reasons, including sex, personal beliefs, cultural factors, and a lack of confidence in vaccine safety and efficacy. The COVID-19 pandemic was controlled using vaccines, but maintaining ideal vaccination coverage is essential to continue reducing hospitalizations and deaths from COVID-19. In Brazil, vaccination coverage did not reach the targeted goal, raising concerns about the ongoing impact of COVID-19.ObjectiveThe study aimed to investigate the prevalence of COVID-19 vaccine hesitancy in Brazil.MethodologyA systematic review with meta-analysis was carried out using the PubMed, Medline, LILACS, and ScienceDirect databases.ResultsIn the search, 238 articles were reviewed, of which 8 were found to be eligible for analysis. The prevalence of vaccine hesitancy was 13.3%, or 0.133 (95% CI = 0.082–0.208), in Brazil. In the subgroup analysis by pandemic wave, the first pandemic wave showed a prevalence of 13.6% or 0.136 (95% CI = 0.081–0.220), while the second pandemic wave had a prevalence of 11.4% or 0.114 (95% CI = 0.029–0.358). Due to heterogeneity, meta-regression showed a significant association between vaccine hesitancy and parents of children and adolescents (Q = 95.55; df = 2; p = <0.0001), indicating that vaccine hesitancy is significantly higher in this population compared to the general population and older adults. Fake news, lack of knowledge, personal beliefs, income, being a woman, being a young male individual without comorbidities, being married with older children, being older, and being asymptomatic were the main factors influencing vaccine hesitancy.ConclusionIn the first meta-analysis conducted in Brazil, vaccine hesitancy was more prevalent among parents of children and adolescents, and vaccine hesitancy decreased in the second pandemic wave. Public policies must be developed to address the factors that interfere with acceptance of the COVID-19 vaccine.

Effective Approaches to Combat Vaccine Hesitancy.

Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia’s federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15–4.90) or a nurse (aOR = 2.12, 95% CI: 1.05–4.25); having a master’s degree (aOR = 5.32, 95% CI: 1.28–22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68–6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15–3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02–2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public’s willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.

As of March 2022, the COVID-19 vaccination rate in Chad approximated 1%. There are no published reports of COVID-19 vaccine hesitancy or beliefs in Chad. We aimed to study COVID-19 vaccine acceptance and hesitancy among community members, patients, and health care workers in urban Chad. We recruited a prospective convenience sample of adult patients, community members, and healthcare workers from N'Djamena, Chad between August-October 2021. Participants completed a 15-minute, 25-question survey instrument exploring demographic, social, and clinical variables related to COVID-19 and an adapted WHO SAGE Vaccine Hesitancy Survey. Primary outcomes were vaccine acceptance and vaccine hesitancy. Regression models were fit to assess associations between Vaccine Hesitancy Scale (VHS) scores, ranging from 10 (least hesitant) to 50 (most hesitant) points, and pre-selected variables of interest. An inductive thematic analysis was used to analyze the qualitative vaccine hesitancy responses. Of 508 participants (32% female; mean age 32 years), 162 were patients, 153 were community members, and 193 were healthcare workers. COVID-19 vaccine acceptance was significantly higher among patients (67%) than community members (44%) or healthcare workers (47%), p < .001. The average VHS score was 29 points (patients = 27.0, community members = 28.9, healthcare workers = 29.4), and more than one-third of participants were classified as highly vaccine hesitant (score >30 points). Knowing someone who died from COVID-19, believing local healthcare workers support vaccination, trusting the government, having a higher socioeconomic status (i.e. having electricity), and reporting medical comorbidities were each associated with less vaccine hesitancy (all p < .05). The vaccine concerns most frequently endorsed were: vaccine side effects (48%), efficacy (38%), safety (34%), concerns about the pharmaceutical industry (27%), and lack of government trust (21%). Four main themes arose from qualitative vaccine hesitancy responses (n = 116): education, trust, clinical concerns, and misinformation and false beliefs. Overall, COVID-19 vaccine acceptance was low, including among health care workers, and reasons for vaccine hesitancy were broad. We detail the most commonly reported concerns of urban Chadians for receiving the COVID-19 vaccine; we also identify subgroups most likely to endorse vaccine hesitancy. These analyses may inform future vaccination outreach campaigns in N'Djamena.

Unpacking Vaccine Hesitancy Among Healthcare Providers

BackgroundIn the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina.MethodsWe conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 –December 15, 2020. Vaccine hesitancy was defined as the response of “no” or “don’t know/not sure” to whether the participant would get the COVID-19 vaccine as soon as it became available.ResultsThe sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]).ConclusionsThis study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.

This study aimed to 1) determine the prevalence and contents of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic and 2) evaluate its association with maternal sociodemographic factors. A cross-sectional survey was conducted between August and December 2020 among pregnant women between 28 and 32 weeks of gestation who received antenatal care at four clinics and hospitals in Niigata City, Japan. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey, and associations between vaccine hesitancy and sociodemographic factors were analyzed. In total, 113/200 (56.5%) subjects responded to the survey. Overall, 46/113 (40.7%) pregnant women were resistant or hesitant to receive the vaccine. Women with vaccine hesitancy were more likely to fear adverse reactions (concern 79.6%, not concerned 15.9%, and not sure 4.4%), safety (concerned 69.0%, not concerned 23.9%, and not sure 7.1%), and efficacy (concerned 47.8%, not concerned 35.4%, and not sure 16.8%) compared to those without vaccine hesitancy (P < .01, < .01, and <.01, respectively). In the multivariate logistic regression analyses, primipara women had higher rates of vaccine hesitancy than multipara pregnant women (odds ratio: 2.38, P = .04). In conclusion, the prevalence of vaccine hesitancy among pregnant Japanese women, especially primipara women, was higher than that in other countries during the COVID-19 pandemic. Their major concerns were adverse reactions, safety, and the efficacy of childhood vaccines. Further strategies are needed to provide appropriate vaccine information to prevent vaccine-preventable diseases in both infants and children.

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. 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. 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). 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.

Objectives: There is evidence of morbidity and mortality in children due to COVID-19 infection. “Vaccine Hesitant Parents (VHPs)” may act as barriers to vaccination of children and their knowledge, attitude, beliefs, and perceptions come into play. Health-care providers are cited as the most important source for vaccine information by VHPs, and provider recommendation for vaccination is crucial for improving vaccine uptake. Hence, we aim to study among Indian health-care professionals having children &lt;18 years of age, the prevalence of parental hesitancy for pediatric COVID-19 vaccine and to assess their knowledge, attitude, beliefs, and perceptions about pediatric COVID-19 vaccine. Methods: An observational, cross-sectional study was conducted across India through a web-based questionnaire amongst health-care professionals having children less than 18 years of age by Snowball sampling technique. Descriptive statistics were used to study the demographic profile, the prevalence of vaccine hesitancy, and individual factors. Correlations between the datasets were obtained using regression analysis and significance level using the Chi-square test. Results: The prevalence of COVID-19 vaccine hesitancy for children in Indian health-care professionals is 3.3%. The most important source of information was the internet and social media. The majority of the participants knew about the vaccine and its side effects (p=0.00) and believed in the usefulness of the vaccine in preventing infection (p=0.008) and in reducing severity (p=0.009). All these factors lead to better vaccine acceptance. Conclusion: These data show that vaccine acceptance has improved over time and thus HCWs can aid in reducing vaccine hesitancy.

ObjectiveThis study aimed to assess the prevalence and determinants of vaccine hesitancy among pregnant women in South-West Nigeria.DesignAn explanatory sequential mixed-methods study was conducted between January and March 2023. Participants for the quantitative phase were selected using a systematic sampling technique, while those for the qualitative phase were purposively selected. A modified parent attitude about childhood vaccines questionnaire was used for data collection and analysed using IBM SPSS V.25.0. Qualitative data were collected through focus group discussions and analysed using NVivo V.14. Univariable, bivariable and multivariable logistic regression analysis was done. A p<0.05 was considered statistically significant.SettingA tertiary health facility in South-West Nigeria.ParticipantsThree hundred and forty-five pregnant women participated in the quantitative phase, while 24 pregnant women were involved in the qualitative phase.ResultsThe overall prevalence of vaccine hesitancy was 32%. Based on the domains, only 15.4% of the respondents were hesitant due to vaccination behaviour, 38.6% for safety and efficacy, and 49.6% were hesitant due to general attitude and trust for healthcare providers. Maternal age, number of children, religion and occupation showed significant association with vaccine hesitancy. Regarding the predictors of vaccine hesitancy, employed pregnant women (adjusted OR (aOR), 4.33; 95% CI: 1.60 to 9.70) and younger pregnant women (aOR, 2.53; 95% CI: 1.04 to 7.70) had a significantly higher odds of being vaccine-hesitant. The qualitative analyses revealed several major themes that contributed to vaccine hesitancy, including concerns about vaccine safety and efficacy, distrust of healthcare providers and the government, and the spread of misinformation through social networks and peers.ConclusionA significant proportion of pregnant women in this study were vaccine-hesitant. The major reasons for vaccine hesitancy are concerns about the safety of vaccines and lack of trust for healthcare providers. Policies and programmes should be aimed at improving vaccination behaviour, addressing safety concerns and building trust in vaccination systems.

IntroductionStudies 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 materialsThis 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.ResultsThe 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).ConclusionsOur 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.