Vaccine Hesitancy Research Articles

Psychometric validation of the Vaccination Attitudes Examination (VAX) scale in German pre-pandemic and mid-pandemic samples

Despite the public health value of immunizations, vaccine hesitancy is a widespread phenomenon and received special attention during the global COVID-19 pandemic. The Vaccination Attitudes Examination (VAX) Scale aims to identify anti-vaccination attitudes for understanding vaccine hesitancy. The present study is the validation of the German version of the VAX scale in pre-/mid-pandemic samples. All individuals completed an online-survey assessing prior and expected future vaccination behaviors, further constructs associated with vaccine hesitancy, as well as anti-vaccination attitudes using the translated VAX scale among others. In a first study, 297 individuals were surveyed before the COVID-19 pandemic. A second study included 260 individuals recruited during the COVID-19 pandemic. For validation, two confirmatory factor analyses have been conducted. Reliability measures (internal consistency, test–retest-correlation) were determined. The four subscales were confirmed by Confirmation Factor Analysis with a very good to excellent fit. The subscales showed good to excellent reliability and convergent validity determinants. Average VAX values significantly distinguished between individuals who had previously received or refused immunization and predicted expected vaccination behavior. The German translation of the VAX scale is effective in identifying anti-vaccination attitudes and can be used for further research on anti-vaccination attitudes and vaccine hesitancy.

Trust in Healthcare, Medical Mistrust, and Health Outcomes in Times of Health Crisis: A Narrative Review

Background/Objectives: The concepts of trust and distrust in health systems during health crises are significantly related to public adoption of health behaviors and health outcomes. The aim of this review is to examine trust and mistrust during times of health crisis, such as periods of viral pandemics and epidemics, and how these concepts relate to public health behaviors and, by extension, affect health outcomes. Methods: A focused search was conducted in PubMed and Scopus using a Boolean expression to identify relevant articles written in the English language and published between 2003 and 2023. The research methods comprised content analysis, thematic analysis, and a word cloud visualization to identify frequent themes related to trust and mistrust in healthcare systems. Results: The analysis included 57 studies and revealed that trust in healthcare systems, institutions, and professionals plays a significant role in shaping public health behaviors during health crises. The study also highlighted how mistrust leads to negative health outcomes, such as increased belief in conspiracy theories, vaccine hesitancy, and non-compliance with public health measures. Conclusions: The review emphasizes the importance of building and maintaining trust in healthcare systems to ensure better public health outcomes during crises. It calls for further research to better understand the nuances of trust and mistrust, aiming to inform public health strategies and interventions that could lead to more effective crisis management and improved health outcomes.

Parents’ and informal caregivers’ experiences of accessing childhood vaccination services within the United Kingdom: a systematic scoping review of empirical evidence

BackgroundDespite repeated calls to action and considerable attention, childhood vaccination uptake has declined for a thirteenth consecutive year in the United Kingdom (UK). Increasingly, stakeholders are advocating for research which goes beyond vaccine hesitancy and explores service accessibility in greater depth. This scoping review aims to identify and critically assess how accessibility is being conceptualised and investigated with a view to informing future research. Research, that in turn, will dictate the interventions pursued to improve vaccination coverage.MethodsA detailed search strategy was implemented across seven databases to identify research exploring parents’ experiences of accessing childhood vaccination services within the UK. The analysis explored the studies in relation to their conceptualisation of access, methodology, reported results, and recommendations for research or practice using a combination of descriptive qualitative content analysis, typologies, and frequency counts. Methods and reporting adhered to the ‘JBI Manual for Evidence Synthesis’ and the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews’.ResultsForty-five studies were included in the analysis. Studies claimed to consider only attitudinal constructs (4%) or did not discuss access at all (33%) despite findings, in part, including access related issues. Remaining studies used the term access in passing or ambiguously (24%), distinguished between attitudes and access in-text (27%), and a minority of studies utilised a theoretical framework which acknowledged accessibility (13%). The focus on access to information (92% of studies) was disproportionately large compared to other domains of accessibility such as availability (11%), affordability (13%), and proximity (16%). Of the seven identified intervention studies, five were centred on information provision.ConclusionAccessibility is poorly conceptualised within most of the research conducted on childhood immunisation uptake within the UK. This, in part, is because exploring accessibility was not an explicit objective of many of the studies included in the review. It is vital that the accessibility of childhood vaccination services is given greater priority and appropriately defined in empirical research. Otherwise, researchers run the risk of limiting the scope of their findings based on their own conceptual ideas regarding the drivers of poor uptake rather than the lived reality of parents.

Contagion comeback: unravelling the measles outbreak across the USA

Measles, a highly contagious respiratory illness caused by the measles virus (MeV), poses significant global and national public health challenges despite advancements in vaccination efforts. Though measles was declared eliminated in the United States in 2000, recent years have seen a resurgence of cases, particularly in under-vaccinated communities. This resurgence is compounded by factors such as vaccine hesitancy, the impact of the COVID-19 pandemic on immunization rates, and international travel introducing new cases from endemic regions. This paper examines the epidemiology and recent measles outbreaks in the United States, focusing on the significant rise in cases from 2020 to 2024. The analysis highlights the importance of maintaining high vaccination coverage, particularly in vulnerable populations, and explores the challenges of managing outbreaks. The study also reviews the pathophysiology, clinical presentation, diagnosis, and treatment of measles, emphasizing the role of prevention and control measures, including the MMR vaccine, public health interventions, and international cooperation in addressing this persistent threat.

Factors associated with COVID-19 vaccine acceptance and hesitancy in children: a comprehensive survey

BackgroundThe COVID-19 pandemic has underscored the significance of immunizations, particularly among susceptible populations such as children. This study examines the factors that influence parents’ decision to accept or hesitate in vaccinating their children in an urban environment.MethodsA one-year cross-sectional study was carried out at a paediatric hospital in Tehran, Iran. The objective is to target a demographic of 226 children, aged 5 to 18, residing in metropolitan locations, over the period of June to August 2023. An extensive survey, built upon previous research, analyzed the variables that influence the reluctance and acceptance of vaccines. Data on demographics, vaccination status, and variables influencing hesitation or acceptance were collected.ResultsOut of the 226 participants, 22.1% of the children had received vaccinations. There was a correlation between parents getting vaccinated and greater rates of child vaccination (100% vs. 92.9%, p = 0.073). Significant relationships were seen between age, parental education, and past COVID-19 hospitalizations. The main motivations for vaccination were to guarantee safety (66%) and to avert serious illness (60%). The primary reasons for hesitancy were primarily attributed to worries regarding potential harmful effects (58%), lack of trust in the vaccine (19.9%), and uncertainties regarding its efficacy (15.9%).ConclusionsThe research emphasizes key factors that have a significant impact on the COVID-19 vaccination of children, such as age, previous hospitalization experiences, and parental attitudes. To boost vaccination rates in this demographic, it would be beneficial to address parental concerns regarding vaccine safety and enhance educational outreach regarding the advantages of vaccines. Public health programs should prioritize clear and open information and precise treatments to decrease vaccine reluctance.

COVID-19 Vaccine Hesitancy: What Have We Learnt? - A Cross-Sectional Survey Among Adults in Tamil Nadu, India

COVID-19 Vaccine Hesitancy: What Have We Learnt? - A Cross-Sectional Survey Among Adults in Tamil Nadu, India

Analysis of public opinion polls about COVID-19 vaccines: Theoretical and policy implications for vaccine communication and campaigns to address vaccine hesitancy

ABSTRACT This study analyzed 1432 questions asked in 19 surveys (N = 43,014) on COVID-19 vaccines between January 2020 and August 2022 using dimensions including (1) information sources about COVID-19 vaccine, (2) information about the access, effectiveness, and side effects of COVID-19 vaccine, (3) COVID-19 vaccine hesitancy (i.e. false perception, skepticism, and vaccine refusal), (4) motivations to get the COVID-19 vaccine (i.e. to perform routine activities, convenience, incentives, influences, and travel requirement), (5) false perceptions caused vaccine refusal, and (6) intentions to get vaccinated. Our results show that vaccine refusal was rampant throughout the pandemic and mostly attributed to the rush in the vaccine development process and perceived safety risks. Additionally, our analysis indicates that people’s motivation to get vaccinated came from varied sources such as doctors, family members, and politicians. Lastly, mandating vaccines during the pandemic did not significantly increase uptake among individuals who were initially skeptical, and concerns about the rapid development of the vaccine were a major cause of vaccine hesitancy. Findings were discussed and interpreted using the information deficit model, the two-step flow theory, and the reactance theory. This research provides valuable insights and practical implications, along with significant theoretical contributions and policy recommendations.

Vaccine Hesitancy Toward COVID-19 Vaccines Among Humanitarian Healthcare Workers in Lebanon, 2021

Refusals and delay in receiving COVID-19 vaccines due to vaccine hesitancy present major barriers to optimal vaccine uptake and thus epidemic control, with crisis-affected populations facing additional challenges. International Medical Corps conducted a cross-sectional survey to evaluate knowledge, attitudes, and perceptions regarding COVID-19 and identify determinants of COVID-19 vaccine hesitancy among 413 healthcare workers (HCW) working at 90 national primary healthcare centers in Lebanon, just prior to widespread vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health belief Model. More than half (56.9%) of HCWs were categorized as being vaccine-hesitant, while 43.1% reported they would receive a vaccine when available. Perceived benefits, cues to action, and social norms were positively associated with vaccine acceptance. More than half (56.4%) believed the national health system was not capable of ensuring safe administration of the COVID-19 vaccine. Targeted interventions that emphasize the benefits of COVID-19 vaccination, highlight cues to vaccinate, and promote vaccination as a social norm are critical in motivating HCWs to get vaccinated. Increasing HCW trust in Lebanon’s national health system is critical to building confidence toward COVID-19 vaccines and has implications for the success of future responses to infectious disease outbreaks.

Vaccination hesitancy among adults in the United Arab Emirates: A vaccine attitudes examination scale study

Vaccination hesitancy among adults in the United Arab Emirates: A vaccine attitudes examination scale study

Parental experience with childhood COVID-19 vaccines and factors associated with parental hesitancy despite being vaccinated: findings of a cross-sectional analysis from Pakistan and implications for the future

ObjectivesThis study examined parental experiences with COVID-19 vaccination and factors contributing to COVID-19 vaccine hesitancy (CVH) among them to help guide future policy initiatives.DesignCross-sectional study.SettingLahore, the second largest metropolis in...

HPV Vaccine Hesitancy and Uptake: A Conceptual Analysis Using Rodgers' Evolutionary Approach.

This study examines the factors contributing to HPV vaccine hesitancy using Rodgers's evolutionary concept analysis, focusing on the impact of uncertainties about the vaccine on HPV-related diseases despite its availability. Rodgers's evolutionary concept analysis was applied to explore factors leading to HPV vaccine hesitancy. The analysis included studies published in English over the past 5 years. Exclusions were studies older than 5 years, non-English publications, and those focusing on other vaccines. A comprehensive literature review was conducted using key databases such as PsycINFO, CINAHL, MEDLINE, and PubMed. Relevant keywords included 'HPV' and 'vaccine hesitancy' to ensure thoroughness. Studies were selected based on their relevance to HPV vaccine hesitancy. Factors contributing to hesitancy were analysed, focusing on antecedents, attributes, and consequences. The analysis identified key antecedents to HPV vaccine hesitancy, including false cultural beliefs, educational level, knowledge, and vaccine availability. Additional factors were insurance/income, perceived risk, and decision-making processes. Key attributes impacting hesitancy included media coverage, environmental and community influences, social factors, trust in healthcare systems, efficacy rates, and safety concerns. The consequences of hesitancy were reduced vaccine uptake, increased HPV-related diseases, and the spread of misinformation. The study highlights the complex interplay of factors contributing to HPV vaccine hesitancy. Understanding these factors is crucial for addressing the challenges posed by vaccine hesitancy and developing effective interventions. Insights from this analysis can guide public health strategies aimed at improving vaccine uptake and reducing HPV-related diseases. Targeted interventions can address misinformation and enhance trust in vaccines, ultimately leading to better public health outcomes. This concept analysis was conducted without the involvement of patients, service users, caregivers, or members of the public.

The Influence of Health Literacy, Social Media Exposure, and Peer Influence on Vaccine Hesitancy among Malaysian Youth

The Influence of Health Literacy, Social Media Exposure, and Peer Influence on Vaccine Hesitancy among Malaysian Youth

The role of interdependent self-construal in mitigating the effect of conspiratorial beliefs on vaccine acceptance.

Infectious diseases pose significant challenges to public health, leading to illness and even death. Vaccinations are vital for protecting society, yet beliefs in conspiracy theories related to infectious diseases increase vaccine hesitancy. This paper delves into vaccination decisions in the context of COVID-19, which continues to strain the health care system. While past research focuses on countering conspiratorial beliefs with cognitive persuasion interventions, we propose a social intervention as an alternative. Our novel intervention seeks to mitigate the effects of conspiratorial beliefs by fostering individuals' interdependent self-construal - viewing oneself in the context of social relationships. Interdependent self-construal was operationalized in multiple ways (measured in Studies 1, 2 and 3; manipulated to test causality in Studies 4 and 5). Conspiratorial beliefs were also manipulated in Study 5. The results show that the association between conspiratorial beliefs and vaccine hesitancy is weakened among individuals whose interdependent self-construal is more accessible. Moreover, this effect was mediated by prosocial motivation. We discuss the implications of our findings for developing and communicating health policies and propose potential contexts where this intervention may be relevant, thereby providing valuable insights into enhancing societal well-being in the face of conspiratorial beliefs.

Vaccination of pregnant women: an overview of European policies and strategies to promote it

Maternal immunization is a valuable tool for protecting mother and unborn child from vaccine-preventable diseases. However, the implementation of strategies for vaccinating pregnant women has only recently gained traction. This work is aimed at providing an overview of European vaccination strategies and gathering evidence on interventions enhancing vaccination knowledge, attitudes, and behaviors (KAB) in pregnant women. To summarize current pregnancy vaccination strategies in Europe, we consulted literature, institutional national health system websites, and the ECDC Vaccine Scheduler. The review of evidence on interventions targeting pregnant women’s vaccination KAB was performed by searching primary studies on PubMed and Web of Science. The 27 EU member states offer various vaccinations in pregnancy, but only 10 recommend all of these: tetanus, pertussis, diphtheria, influenza, and COVID-19, albeit with different administration schedules. The literature review included 7 studies, 3 from Italy and 4 from other European countries (UK, Netherlands, Greece, Poland, and Ukraine). They were conducted in various settings such as childbirth preparation courses, prenatal visits, and online platforms, and all included educational interventions providing information on vaccine safety and efficacy during pregnancy. Knowledge about vaccines and vaccine-preventable diseases, generally low in the pre-intervention period, increased post-intervention, with a rise in awareness of the risks associated with infectious diseases and the recommended vaccines, a reduction in vaccine-related misinformation, and a greater propensity to vaccinate both newborns and themselves. Furthermore, there was a significant increase in adherence to recommended vaccinations, particularly among those with higher educational levels. However, vaccine hesitancy persisted, influenced by factors such as fear of adverse events and the lack of recommendations from healthcare providers. Variations in pregnancy vaccination strategies across Europe emphasize the importance of establishing a unified framework to optimize maternal and fetal health outcomes through evidence-based policies. Educational interventions may positively impact pregnant women’s KAB, therefore promoting vaccination uptake.

Using framing and nudging to increase COVID-19 vaccine willingness: An experimental study

Many people are hesitant or unwilling to take advantage of potentially life-saving vaccines; this is true even in a global pandemic and even when vaccines are readily available and/or free. Apart from general unwillingness to be vaccinated, fear of side effects is a frequently named reason for vaccine hesitation. This survey-based study, carried out online in Austria in March of 2021, examines the efficacy of two different approaches – framing and nudging – in promoting a fictional COVID-19 vaccine program. While nudging had no visible effects, either positive or negative, framing was associated with more positive feelings toward the campaign and a greater intention to be vaccinated, though only among those already pre-disposed to get the vaccine. Governments and healthcare organizations are eager to find low-cost measures to increase vaccination rates for COVID-19 and other diseases. This study’s results suggest that addressing and positively framing the high likelihood of problem-free vaccinations should form an integral part of public messages, but that this approach may be ineffective among those who are strongly hesitant or unwilling. AcknowledgementSupported by funds from the province of Tyrol.

Vaccine Hesitancy Among Healthcare and Public Health Workers in New Zealand: The Impact of COVID-19 Pandemic.

Vaccine Hesitancy Among Healthcare and Public Health Workers in New Zealand: The Impact of COVID-19 Pandemic.

Association of vaccine intention against COVID-19 using the 5C Scale and its constructs: a Pima County, Arizona cross-sectional survey.

Vaccine hesitancy has been ranked as one of the top 10 threats to global health by the World Health Organization. The 5C model (Confidence, Calculation of risk, Complacency, Collective Responsibility, and Constraints) and an accompanying tool to measure vaccine hesitancy, summarize several significant explanatory variables, and move beyond the most common explanatory variable, Confidence. From January to May 2021, we administered a cross-sectional survey among adults in Pima County, Arizona in collaboration with the local health department to assess psychological antecedents to (i.e., psychological factors that lead to) COVID-19 vaccination using the 5C Scale. Participants were recruited virtually for the survey using multiple recruitment methods. Unadjusted and adjusted hierarchical ordinal logistic regressions were conducted to determine if the 5C variables had an association with intention to vaccinate (or intent to vaccinate) against COVID-19. Of the 1,823 participants who responded to the survey, 924 (76%) were included in the final analyses. Respondents were White (71%), non-Hispanic (59%), Female (68%), Liberal (37%) and Married (46%). The average age of the participants was 43.9 (±1.3) years. Based on the 5C Scale, Confidence (adjOR:3.64, CI [3.08-4.29]), Collective Responsibility (adjOR:1.94, CI [1.57-2.39]) and Complacency (adjOR:0.64, CI [0.51-0.80]) were significantly associated with intention to vaccinate against COVID-19. Three of the five 5C variables were associated with the intention to vaccinate, two positively and one negatively. A limitation of the study was that the sample was not weighted to be representative of Pima County. Future research should focus on determining which interventions can bolster Confidence and Collective Responsibility attitudes in communities, while dampening Complacency, to better promote vaccine uptake.

The effect of coronavirus disease 2019 vaccination on pregnant women: A scoping review

Background: Globally, reports have shown that pregnant women refuse to receive the coronavirus disease 2019 (COVID-19) vaccine. This has posed a significant concern given the global impact of the COVID-19 pandemic.Aim: This study aims to explore the current evidence on the effect of COVID-19 vaccination on pregnant women.Method: A scoping review was conducted using Levac et al.’s five-stage framework. Relevant articles were searched in the Web of Science, PubMed, Scopus and EBSCOhost (CINAHL) databases. The identified articles were screened based on predetermined inclusion and exclusion criteria. Data from the selected articles were charted and summarised into meaningful units.Results: Twelve articles from developed countries were included in the review. Studies have reported that COVID-19 vaccination during pregnancy is generally safe and does not increase the risk of pregnancy complications. There was no significant difference in delivery outcomes between vaccinated and unvaccinated women. Neonatal outcomes were not affected by the vaccination. However, one study identified a potential risk of spontaneous abortion between 6 and 9 weeks of gestation among vaccinated women.Conclusion: Coronavirus disease 2019 vaccination is considered safe during pregnancy. While some studies have identified potential associations with certain conditions, the overall benefits of vaccination outweigh the risks. Continued monitoring of the safety and effectiveness of COVID-19 vaccines during pregnancy is recommended. Pregnant women should consult healthcare providers to make informed decisions regarding vaccination.Contribution: The findings of this review may assist in alleviating anxiety and reducing vaccine hesitancy among pregnant women.

Exploratory assessment of the parent attitudes about childhood vaccines survey tool to assess vaccine hesitancy and pet vaccination status among pet owners.

To assess the applicability of the parent attitudes about childhood vaccines (PACV) survey to pet owners and its association with vaccine hesitancy. A national survey including an adapted version of the PACV was administered to 2,853 dog and 1,977 cat owners. Respondents were queried about the vaccination status of their pets. Exploratory factor analysis, Mokken scale analysis, Cronbach α, McDonald ω, and bivariate analyses were used to assess the validity and reliability of the PACV and shortened versions. The Fisher exact test and linear probability models were used to assess the association between the PACV and other factors and vaccination status. The PACVs for pet owners were valid and reliable with high internal consistency and served as correlates for vaccination status. In multivariate analyses, long-term relationships with veterinarians were also associated with vaccination. Individual survey items indicated substantial concerns about vaccine safety, side effects, and efficacy. Most respondents indicated trust and good relationships with their veterinarian, had not avoided or delayed vaccinations, understood the severity of pet diseases, supported the recommended vaccine schedule, and did not self-identify as vaccine hesitant (VH). The PACV identified 21.7% of dogs and 25.9% of cat owners as VH. The full and the reduced versions of the PACV are valid and reliable tools to assess VH status in dog and cat owners. The PACV could serve as an important tool for veterinary researchers to identify factors associated with vaccine hesitancy and develop effective interventions.

Health and socio-demographic background of Ukrainian minors and their families in Germany - challenges for refugee medicine

In 2022, over 1,000,000 people from Ukraine fled to Germany, mostly women and children. The aim of this study was to determine health status and socio-demographic background of Ukrainian refugee minors in Germany and to compare that to German minors. In this study, Ukrainian refugees of all ages, who voluntarily made contact with the study centres via flyers or refugee shelters, were interviewed with the help of trained interpreters from 09–12/2022. We assessed data from minors and their families on socio-economic status, general health perception, current and pre-existing infectious and non-contagious diseases, and vaccination status. The data for the minors were collected by interviewing the accompanying adults. In addition, a physical examination and serological screening for infectious and vaccine-preventable diseases were performed. Overall, 392 minors and accompanying adults (358) were included. Minors’ general and mental health were reported as “at least good" in 83% (316) and 80% (304), respectively. In 16% (63), infectious or other underlying diseases were recorded. Tuberculosis infections (7, 1.8%) and hepatitis C (2, 0.5%) were found through the serological tests. HIV could only be detected in one previously known case. Self-reported vaccinations against measles and varicella, for example, did not match serological findings (protection against measles 304; 84%; varicella 230; 64%). Conclusion: Accompanying adults often rate the general health and well-being of Ukrainian refugee minors as rather poor. Frequently, self-reported vaccinations and preexisting diseases did not match serology results; therefore, Ukrainian refugee minors without formal vaccination certificate should be offered all recommended vaccinations and be generously screened for hepatitis B, C and HIV in addition to tuberculosis.What is Known:• Infectious diseases (TB, hepatitis B/C, HIV) are more common among Ukrainian minors and vaccine hesitancy is more widespread than in many host countries and require appropriate medical care.• Displacement and war worsen medical care and have negative impact on mental health..What is New:• Although intrafamilial spread of infectious diseases was rare (in this cohort), perceived general health of Ukrainian minors is rather poor.• Semi-structured interviews—even with interpreters—are often insufficient to collect valid medical information.