Vaccine Acceptance Research Articles

Designing persuasive communication models for vaccine acceptance in isolated communities: A mass communication approach

This study introduces the Persuasive Communication Model as a novel approach to address vaccine hesitancy in isolated U.S. communities, where infectious diseases such as measles and influenza continue to pose significant public health threats. By integrating mass communication theories like the Elaboration Likelihood Model (ELM) and Social Cognitive Theory (SCT), with AI-driven message personalization, the model effectively tailors health communication strategies to the cultural, cognitive, and socio-economic contexts of vaccine-hesitant populations. In a randomized controlled trial, the model increased vaccination uptake by over 20% compared to traditional methods, while also enhancing trust in healthcare systems. The model’s adaptive communication, utilizing both digital platforms and community leaders, was instrumental in overcoming barriers related to geographic isolation, religious beliefs, and cultural resistance. These findings are particularly relevant for enhancing national public health security and reducing the economic burden of vaccine-preventable diseases. The study highlights the model's superiority over static communication frameworks, offering scalable applications for broader public health interventions.

Mpox Vaccine Hesitancy Among Brazilian Men Who Have Sex with Men: A National Cross-Sectional Study

Background: Mpox is a viral zoonosis that has gained increased attention due to a global outbreak in 2022, significantly impacting men who have sex with men (MSM). Vaccination for this disease poses a public health challenge; because it carries a strong stigma, there may be greater hesitancy in vulnerable groups. Objectives: This study aimed to determine the prevalence and factors associated with Mpox vaccine hesitancy among Brazilian MSM. Methods: A cross-sectional study was conducted between September and December 2022 using an online survey targeted at MSM. Recruitment was carried out through social media and dating apps. The sample consisted of 1449 participants and the analysis involved bivariate logistic regression. Results: The prevalence of Mpox vaccine hesitancy was 7.57%. The significant factors associated with hesitancy were primarily related to sexual practices and attitudes towards Mpox exposure and diagnosis, such as not using “glory holes” (aOR: 19.82; 95% CI: 1.60–245.69), reluctance to undergo pre- and post-exposure testing for Mpox (aOR: 9.54; 95% CI: 5.52–16.48), and not knowing close contacts diagnosed with Mpox (aOR: 4.09; 95% CI: 1.72–9.73). Participants who would not take precautions after diagnosis (aOR: 3.00; 95% CI: 1.27–7.07) and those who would not disclose their serological status (aOR: 1.93; 95% CI: 1.13–3.30) also showed a higher likelihood of vaccine hesitancy. Conclusion: Public health strategies should address these factors to expand knowledge about vaccination barriers, plan educational campaigns with targeted messaging for the MSM population, and provide inclusive healthcare environments to increase vaccine acceptance and reduce Mpox transmission in vulnerable groups.

Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria

BackgroundThe unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.MethodsThis qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four ‘Cis’) Determinants of Vaccination Acceptance Conceptual Framework – Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.ResultsThe many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual’s condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.ConclusionThe evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

Evaluating the psychological antecedents of vaccination in applicants to primary health care centers

Abstract Background Vaccine acceptance can be enhanced by understanding the psychological antecedents of vaccination. The 5C model identifies relevant factors: confidence, complacency, constraints, calculation, and collective responsibility. This study aims to evaluate these factors among primary health care center applicants in Ankara. Methods A total of 1712 individuals aged 18 and over, who visited primary health care centers, participated in the study. The face-to-face survey included questions about sociodemographic characteristics, Vaccination Psychological Antecedents Scale, individuals’ attitudes and behaviors towards vaccination, and internet usage. Factors with a significance level of p < 0.20 from previous analyses were assessed using multivariate logistic regression analysis. The factors influencing the decision to get vaccinated without hesitation when necessary were investigated. Results The likelihood of getting vaccinated without hesitation in necessary situations is higher among those with higher income than expenditure(OR:1,517, 95%CI=1,094-2,104), those without chronic diseases in their family(OR:1,411, 95%CI=1,109-1,795), and those who do not actively use social media(OR:1,380, 95%CI=1,051-1,813). Additionally, an increase in the confidence score(OR:1,276, 95%CI=1,239-1,315) and the collective responsibility score(OR:1,096, 95%CI=1,058-1,134), was associated with an increased likelihood, while an increase in the calculation dimension(OR:0,928, 95%CI=0,895-0,962) was associated with a decreased likelihood. Conclusions Income status, presence of chronic illness in the family, active social media usage, confidence, collective responsibility, and calculation are factors influencing vaccine acceptance without hesitation. Communication strategies based on trust and collective responsibility should be developed to improve vaccine acceptance. The risk factors causing vaccine hesitancy among social media users should be investigated, and measures should be taken. Key messages • Develop trust-based, collective responsibility-focused communication to boost vaccine acceptance. • Investigate and address social media-driven vaccine hesitancy.

Active offer of influenza vaccination during hospitalization: a multicenter study in Sicily (Italy)

Abstract Background Every cold season, the Italian health institutions strongly recommend influenza vaccination for categories at risk of complications, however influenza vaccination coverage is over and over far from the desirable target of 95%. After the pilot experience conducted in Palermo during the 2022-23 influenza season, the ‘Vaccinations in the ward’ project was extended to other Sicilian centers in order to evaluate the impact of the vaccination offer strategy in a broader territorial reality and to analyze the determinants of influenza vaccine acceptance among at risk people. Methods The project was conducted at the Umberto I Hospital in Enna and the University Hospitals of Messina and Palermo during the 2023-24 influenza season. A questionnaire was administered to the at risk hospitalized patients to investigate socio-demographic factors, behavioral habits, and clinical condition. Furthermore, influenza vaccination upon discharge was offered. Multivariable logistic regression was performed to identify the determinants of influenza vaccine acceptance. Results Overall, 374 patients with a median age of 65 years (IQR: 50-70) were recruited, of whom 36% had been vaccinated for influenza during the 2022-23 season (n = 136). The patients who accepted influenza vaccination in the ward were 57% (n = 214). The determinants of vaccination adherence were: age (OR: 1.03; p = 0.003); having quit smoking (OR: 2.68; p = 0.017); having received advice on vaccination from general practitioner (OR: 4.9; p < 0.001) and hospital healthcare workers (OR: 7.3; p < 0.001). Conclusions The offer of vaccination in the ward effectively increased influenza coverage among categories at risk of complications. Furthermore, the adoption of correct behavioral habits and the promotion of influenza vaccination by healthcare personnel have played a decisive role in the vaccine acceptance process. These findings could be useful for planning future influenza vaccination campaigns targeted to at risk people. Key messages • Vaccination strategies are needed to increase influenza coverage among at-risk categories. Active offer of influenza vaccine upon discharge can effectively increase vaccination compliance. • The adoption of correct behavioral habits and the promotion of vaccination by healthcare personnel play a decisive role in the influenza vaccine acceptance process among at risk people.

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

Educational and communication strategies to promote HPV vaccination: A Systematic Review

Abstract Background Despite the evidence supporting the value of vaccination, Cervical Cancer (CC) and HPV-related diseases still represents a public health challenge, requiring international efforts to address all barriers that can reduce vaccine acceptance and equitable uptake. In this context, implementing interventions aimed at enhancing knowledge levels within target populations emerges as a crucial approach to improve vaccination coverage. Thus, this study conducted within the PERCH project (PartnERship to Contrast HPV), aimed to explore all educational interventions/communication strategies adopted at the international level to improve HPV vaccine uptake. Methods A systematic literature review was conducted by querying three databases from July 1, 2006 (the time of the first HPV vaccine licensure) to January 30, 2024. It included studies focused on educational interventions/communication strategies adopted by healthcare providers (HCPs) targeting the World Health Organization (WHO)-recommended population for HPV vaccination, as well as parents, caregivers, teachers, and other influential individuals involved in vaccination decision-making. Results Overall, 16 studies were considered, with 68.7% (11/16) focusing on educational initiatives and 50% (8/16) on communication strategies. Regarding the target population, 19% (3/16) involved parents/caregivers, 25% (4/16) included both parents and adolescents, and the remaining 56% (9/16) targeted adolescents/young adults. Videos were the most commonly used channel for both types of interventions (54%), followed by informative materials (31%), person-to-person solicitation (17%), social media (15%) and slide presentations (23%). Conclusions Understanding the strengths and weaknesses in HPV knowledge and communication is crucial for developing effective, tailored strategies to disseminate reliable information and promote evidence-based knowledge, thereby implementing high-value healthcare. Key messages • Effective communication of vaccination’s value to stakeholders is essential for informing health policies, guiding best practices, and countering misinformation. • Further research is needed to develop interventions that effectively increase HPV vaccine acceptance, aligning with the WHO’s goals to eliminate CC and HPV-related diseases.

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.

Developing an infodemic management toolkit for immunization: An iterative consultation process

Abstract Issue An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform an emergency response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights and contextualize these insights in relation to other programme data. Description The WHO and UNICEF ‘how to build an infodemic insights report in 6 steps’ document provides general guidance. A more immunization specific document, with practical and specific tools in standalone short focus areas was developed to guide infodemic managers or those working on vaccine demand and acceptance, and by vaccination field workers. The toolkit is intended for vaccines across the life course, including for children, adolescents, pregnant people, adults, and people with pre-existing conditions or have other vulnerabilities. Results Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels. Lessons The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives. Key messages • For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake, and manage vaccine-related events. • Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox.

2.I. Scientific session: Addressing vaccine hesitancy: from understanding determinants to implementing targeted strategies

Abstract Supported by NextGenerationEU (no. PE00000007) and EU4Health (VAXaction), the workshop will present a pan-European perspective on vaccine hesitancy and the effectiveness of counteracting interventions, especially when facing potentially pandemic infectious threats. Analysing human responses to epidemics is crucial to improve mathematical disease modelling and develop strategies to monitor behaviours during outbreaks, including assessing levels of vaccine hesitancy. This session will explore the multifaceted issue of vaccine hesitancy, which remains a significant barrier to achieving optimal vaccination coverage and is identified as one of the top threats to global health. By integrating theoretical frameworks with practical applications, the workshop aims to present a comprehensive overview of strategies employed to mitigate hesitancy across various demographics and regions. The first presentation will cover a thorough overview of the strategies employed to counteract vaccine hesitancy, leveraging existing infrastructure, health promotion policies, and educational initiatives. It will also explore the role of digital health tools and regulatory measures, such as health passes and nudging techniques, in enhancing vaccination uptake. Furthermore, the session will cover a systematic review of immunisation information systems (IISs) and the proposal of an innovative unvaccinated registry. This part of the workshop will delve into technological advancements and the integration of behavioural insights, which are essential for enhancing vaccine coverage and informing public health strategies. Another significant aspect of the discussion will be the evolution of vaccine mandates, from their historical roots to their contemporary applications. This discussion will reflect on policy shifts necessitated by emerging public health challenges and the need for adaptable strategies that can respond effectively to fluctuating vaccine coverage and acceptance rates. Panel discussions will feature notable experts such as Prof. Carlo Signorelli, President of the Italian NITAG, and Prof. Maria Ganczak, Vice President of the EUPHA Infectious Diseases Control section. These discussions will provide a comparative analysis of vaccination policies across different European countries, highlighting diverse approaches to mandates and the implementation of public health interventions aimed at combating vaccine hesitancy. By providing a unified approach to understanding and combating vaccine hesitancy, we aim to facilitate a critical exchange of ideas and strategies among experts in the field. It will serve as a dynamic platform for discussing evidence-based interventions tailored to specific population needs, enhancing public health outcomes across Europe. This engaging session promises to offer valuable insights into the complexities of vaccine hesitancy and the collaborative efforts required to address this global health challenge effectively. Key messages • Enhanced data collection and analysis are essential to combat vaccine hesitancy, allowing for tailored interventions that address specific community needs and barriers to vaccination. • Effective strategies against vaccine hesitancy require historical understanding and flexibility to adapt to new challenges, ensuring public health policies are responsive and culturally sensitive.

Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK

Abstract Introduction Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK. Methods We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines. Findings Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns Conclusions Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake. Key messages • Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine. • Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.

Prevalence and sociodemographic correlates of COVID-19 vaccine acceptance in 20 European countries

Abstract Our study aimed to analyze the prevalence and socio-economic factors associated with COVID-19 vaccine hesitancy using individual data from representative national samples of 20 European countries. Data from round 10 of the European Social Survey, collected from May 2021 to September 2022, were analyzed. Prevalence (with a 95% confidence interval (CI 95%)) of participants’ intention to get vaccinated against COVID-19 was calculated. Crude differences in vaccine hesitancy proportions across sociodemographic strata were assessed using the Chi-square test. There were 31,771 adult participants (46.0 % men). The percentage of those hesitant (i.e. those who were not already vaccinated and intended not to be) toward the COVID-19 vaccine was 18.0% (CI 95% 17.6 - 18.4). Men and women were equally hesitant (18.0% vs. 18.0%, p = 0.93). There were differences between those under 40 (22.9%), adults between 40 and 59 (18.1%), and those over 60 (14.3%, p < 0.001). The unemployed had a higher proportion of hesitancy (32.9%) compared to the employed (17.4%), retirees (14.8%), and students (21.1%, p < 0.001). People living in rural areas have higher levels of hesitancy compared to those in urban areas (19.3% vs. 17.3%, p < 0.001). The estimates indicate that the highest prevalence of vaccine hesitancy was in Bulgaria (61.6%), Slovenia (40.4%) and Slovakia (30.7%), while Iceland (2.3%), Portugal (3.6%) and Italy (4.0%) had the lowest. Our study confirms high prevalence and high variability of hesitancy towards COVID-19 vaccines in Europe and identify groups for potential targeted interventions.

Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study.

Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents' preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.

Cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitudes Examination (VAX-U) scale.

Martin and Petrie developed the Vaccine Attitudes Examination (VAX) scale with an aim to document general vaccination attitudes. Vaccine acceptance plays an important role in curbing COVID-19 infections. Thus, it was important to assess vaccination attitudes of Pakistani people towards novel COVID-19 vaccines. The VAX scale was not available in Urdu language for Pakistani population. The study aimed to carry out cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitude Examination (VAX) scale in a selected population sample from Pakistan. A cross sectional study was conducted in September 2021 in an outpatient department of a healthcare facility in Karachi, Pakistan. Adult visitors, eligible for COVID-19 vaccine and spoke Urdu as first language were invited. Convenient sampling was used, and sample size was based on an item response ratio of 1:20. An Urdu version of the VAX scale was developed. The reliability was assessed using Cronbach's alpha (α) and intraclass correlation coefficient (ICC). The model fitness was evaluated using confirmatory factor analysis (CFA) and fit indices namely goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). A structural equation model (SEM) was also developed. IBM SPSS and AMOS were used to analyse the data. The study had ethical clearance. A total of 211 responses were analysed. The reliability (Cronbach's α) was 0.821. The ICC was 0.831 (95% CI: 0.795-0.863). CFA using a 4-factor model revealed the following values for fit indices; GFI = 0.944, AGFI = 0.909, TLI = 0.953, CFI = 0.966, and RMSEA = 0.051. All values reported were in the acceptable range. The VAX Urdu version is a reliable and valid instrument for use in an Urdu speaking population and will enable clinicians to assess the public's attitude towards general vaccination including COVID-19 vaccination. Clinicians can use the VAX-U to document a person's vaccine hesitancy and tailor their counselling to address the issues in vaccine uptake.

Comparing role of religion in perception of the COVID-19 vaccines in Africa and Asia Pacific

BackgroundIn the midst of the global COVID-19 vaccine distribution challenge, religion stands out as a key determinant of vaccine hesitancy and health choices. Notably, the multifaceted religious environments of Africa and the Asia Pacific remain under-researched in this context.MethodsUtilizing data from two survey waves conducted between 2021 and 2022, this cross-sectional study investigated the effects of religious beliefs on perceptions of compatibility between religion and vaccines and COVID-19 vaccine acceptance in Africa and Asia Pacific. Logistic regression models were employed, with interaction terms between socio-economic factors incorporated to account for variations among diverse subpopulations.ResultsAmong the eight religious groups identified, Atheists and Buddhists in the Asia Pacific exhibit the lowest agreement, with fewer than 60% acknowledging the religious compatibility of vaccines. Willingness to accept vaccines, however, is consistently higher in Asia Pacific by at least four percentage points compared to Africa, with the disparity widening further in the second wave. Impacts of education on vaccine perceptions vary across religious groups, while acknowledging vaccine compatibility with religion positively contributed to vaccine acceptance. Dynamics between region, religion, and other socio-demographic factors have changed substantially over time. All but Atheists and Muslims exhibit a higher propensity to endorse vaccines during Survey Wave 2.ConclusionsOur study reveals complex, context-dependent connections between vaccine attitudes and religion and the heterogeneous effects of time and education among different religious affiliations. Understanding the underlying drivers of these temporal variations helps inform tailored approaches aimed at addressing vaccine hesitancy, promoting vaccine uptake, and improving the well-being of each religious group.

Trust in Health Institutions Across Racial Groups: Implications for Dual Flu-Coronavirus Vaccine Adoption.

This study employs t-tests to compare the means of trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake between individuals who are willing and unwilling to accept the combined vaccine. Additionally, a weighted logistic regression analysis is conducted to predict the likelihood of individuals to receive the combined vaccine, considering key independent and control variables. The t-test results reveal that individuals who are willing to accept the combined vaccine exhibit higher levels of trust in health institutions, more frequent flu vaccine uptake, and higher COVID-19 vaccine uptake. This pattern holds true across all racial groups. The logistic regression analysis demonstrates that trust in health institutions, frequency of flu vaccine uptake, and COVID-19 vaccine uptake significantly predict individuals' willingness to accept the combined vaccine. Partisanship and demographic characteristics also exert influence on vaccine acceptance. Trust in health institutions plays a pivotal role in vaccine acceptance among individuals from all racial groups. Encouraging routine vaccination practices and leveraging existing vaccination campaigns can facilitate the adoption of combined vaccines. It is imperative to address racial disparities and tailor communication strategies to specific demographic groups to enhance vaccine uptake.

Factors affecting human papillomavirus vaccine acceptance among parents of Primary 4 to 6 boys and girls in Hong Kong.

Human papillomavirus (HPV) poses a substantial but underestimated healthcare burden in Hong Kong. This study investigated factors affecting parental acceptance of HPV vaccination after the introduction of an immunisation programme for primary school girls. We assessed parental perceptions and related factors concerning HPV vaccination for both boys and girls. We conducted a cross-sectional survey between December 2021 and February 2022 among parents of Primary 4 to 6 students in Hong Kong. Our self-administered online survey collected data regarding socio-demographic characteristics, awareness and knowledge of HPV vaccination, attitudes towards HPV vaccination, and acceptance of HPV vaccination. Characteristics were compared between boys' parents and girls' parents. Factors associated with vaccine acceptance were analysed by multivariate logistic regression. We observed high awareness of HPV vaccination among boys' parents and girls' parents; however, they demonstrated relatively poor knowledge of HPV and the HPV vaccine. An alarming low HPV vaccination uptake rate was also observed. Attitudes towards the HPV vaccine were similar between parent groups. A majority of parents believed that the HPV vaccine was safe and effective in preventing infection. Parents of boys showed lower HPV vaccine acceptance. Factors associated with acceptance differed between parent groups. High awareness of HPV and HPV vaccine is predictive of vaccine acceptance. Boys' parents are less likely to accept HPV vaccination and emphasis should be placed on addressing potential HPV vaccine hesitancy in this group. Public education should also aim to raise awareness of government vaccination programme, and implementation of catch-up vaccination programme to school children beyond primary school should be considered.

Understanding Factors Responsible for Delay and Non-Compliance in COVID-19 Vaccination at a Tertiary Care Hospital in Mumbai, India

Background: Despite extensive first-dose coverage, delays in second doses and late first doses prompted a study on vaccine hesitancy and non-compliance. Methods: In 2022, a cross-sectional survey was conducted at a Mumbai vaccination center, involving 504 individuals who had received either the first or second dose of the COVID-19 vaccine. The study, conducted from February to April 2022, included interviews using a pre-validated schedule to assess vaccine acceptance, refusal, socio-demographics, and reasons for hesitancy. Data analysis was performed using IBM SPSS Statistics software 23.0 to understand factors influencing vaccine delay and non-compliance. Result: The study interviewed 504 participants at a Mumbai vaccination center. Most were male (63.9%), aged 18-44 (80%), and skilled workers (22.6%). Of those surveyed, 64 had received only the first vaccine dose. The delay in receiving the second dose was 37.4% for BBV152 and 41% for ChAdOx1 nCoV-19. The primary reason for delay was lack of time (50.6%), followed by fear of the vaccine (14.8%). Reasons for getting vaccinated later included resolving constraints (40.5%) and compulsion (25.8%). Vaccine choice reasons varied significantly (p &lt; 0.0005), but delay proportions were similar across vaccines (p = 0.531). Conclusion: Even after many efforts by the government, large numbers of people have not taken vaccine on time. One of the reasons, as seen in the study is a busy work schedule which has hindered timely vaccination in individuals. Making vaccine available at work place may address this issue to some extent, besides ownership of the program by the public.

The acceptance of COVID-19 vaccines in Rwanda: a cross-sectional study

The first reported case of Coronavirus Disease 2019 (COVID-19) in Rwanda occurred on March 14 2020. By the end of July 2024, a total of 133,518 individuals had tested positive for the infection, resulting in 1,468 deaths and 132,039 had fully recovered. The success of COVID-19 elimination in Rwanda hinges on the public’s level of acceptance of the COVID-19 vaccination. Although COVID-19 is no longer a pandemic anymore, the World Health Organisation recommends countries vaccinate their populations to protect them from COVID-19 and its variants. Globally, COVID-19 has affected 704,753,890 people, caused 7,010,681 deaths and 675,619,811 have recovered. This study aimed to assess the acceptability of COVID-19 vaccines among adults aged 18 years and above in Rwanda. A cross-sectional study was conducted from January to March 2022 to determine the associations between COVID-19 vaccine acceptance (VA) with respondents’ characteristics, using logistic regression analysis. This study enrolled 2,126 respondents with a mean age of 31 years, the majority of whom were females (82.2%), 51.4% had completed primary education, and 78.7% were married. Most respondents recognized the importance of COVID-19 vaccination for both personal health and community well-being. The study found a high rate of COVID-19 vaccine acceptance, with 91.6% of respondents expressing VA and an overall VA rate of 98.2%. Having a relationship with the child(ren) was the only characteristic associated with COVID-19 vaccine acceptance (p; 3.2 × 10− 3, OR; 2.9, 95% C.I; 1.4–5.9). In conclusion, the study found a high rate of COVID-19 vaccine acceptance among adults in Rwanda, with COVID-19 associated with having a relationship with the child(ren). The study recommends the need for mass educational campaigns and awareness-raising efforts to understand of COVID-19 vaccines.

Nationwide Discrete Choice Experiment on Chinese Guardians’ Preferences for HPV Vaccination for Mothers and Daughters

Background: HPV vaccination is the key measure to prevent cervical cancer, but uptake in China lags behind global targets. Understanding Chinese guardians’ preferences is key to improving vaccine acceptance and coverage. Methods: A nationwide online discrete choice experiment survey was conducted among 4933 Chinese guardians across seven provinces in 2022 to quantify preferences and willingness to pay. Attributes included effectiveness, safety, duration, valency, location, and out-of-pocket cost. Results: Out of the 4933 guardians who participated in the study, 4179 (84.72%) were mothers. More than 60% of the guardians belonged to the age group of 35–44 years. Additionally, over half of the respondents (53.15%) had daughters between the ages of 9 and 14 years. Respondents were open to accepting the HPV vaccine with 95% efficacy and exceptional safety. Guardians expressed a preference for longer protection duration (specifically 15 years (βa = 0.340, 95% CI: 0.31, 0.37)) and higher vaccine valency. As for willingness to pay, the respondents placed the highest value on vaccine efficacy, being willing to shell out more than USD 1100 for 95% protection as compared to 50%. Furthermore, very good safety commanded a premium of over USD 800 when compared to average safety. When it comes to willingness to uptake, a vaccine with 95% efficacy led to a more than 35% increase in acceptance as compared to one with 50% efficacy. Similarly, exceptional safety resulted in an increased willingness to uptake of over 25% when compared to average safety. Conclusions: The DCE highlighted effectiveness, safety, and durability as critical drivers of HPV vaccine acceptance, but substantial barriers persist regarding adolescent female coverage in China.