Vaccine Hesitancy Research Articles

Vaccine Hesitancy at Nine Community Sites Across the United States, Early in COVID-19 Vaccine Rollout.

Vaccine hesitancy has been a significant concern throughout the COVID-19 pandemic. Vaccine hesitancy can be attributed to lack of confidence in vaccines, complacency about the health threat, or lack of convenience of vaccination. To date, few studies have used methods designed to include populations underrepresented in research when identifying factors associated with vaccine hesitancy. Between January and July 2021, potential participants were recruited from community venues selected through time-location sampling in 15 defined communities in the United States. Study staff administered a questionnaire on demographics, COVID-19 behaviors and attitudes, and vaccination status or intention to consenting individuals. Vaccine hesitancy was analyzed among those age 18years and older from nine of the 15 sites and was defined as self-reported neutral, unlikely, or very unlikely vaccine intention. Logistic regression modeling, adjusted for site, identified factors associated with vaccine hesitancy. Among 11,559 individuals, vaccine hesitancy by site ranged from 8.7 to 31.1%. Vaccine hesitancy was associated with being Black compared to White, being White compared to Asian, younger age, unstable housing, being unemployed, lower income, having a disability, providing care in home, not reporting inability to visit sick or elderly relatives during the pandemic, not reporting increased anxiety during the pandemic, and not spending more time with loved ones during the pandemic. In these selected US communities, early in vaccine rollout, there were significant racial disparities in vaccine hesitancy. Additionally, individuals who were more marginalized due to their socioeconomic status were more likely to report vaccine hesitancy. Vaccine campaigns should make efforts to remove barriers to vaccination, by improving convenience.

Progress Toward Poliomyelitis Eradication - Pakistan, January 2023-June 2024.

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy.

Predictors of Change in Vaccination Decisions Among the Vaccine Hesitant: Examining the Roles of Age and Intolerance of Uncertainty.

Vaccine hesitancy and resistance pose significant threats to controlling pandemics and preventing infectious diseases. In a group of individuals unvaccinated against the disease caused by the SARS-CoV-2 coronavirus (COVID-19), we investigated how age, intolerance of uncertainty (IU), and their interaction affected the likelihood of having changed one's vaccination decision a year later. We hypothesized that higher IU would increase the likelihood of becoming vaccinated, particularly among individuals of younger age. We predicted that this effect would remain significant, even after controlling for delay discounting and trust in science. The goal of this research was to understand the factors influencing changes in vaccination decisions among the vaccine hesitant. In a larger longitudinal study, ~7,500 participants from Prolific.co completed demographic and vaccination status questions, a delay discounting task, and the Intolerance of Uncertainty Scale in June-August 2021. Approximately 3,200 participants completed a follow-up survey in July-August 2022, answering questions about vaccination status, reasons for vaccination decision, and trust in science. We analyzed data from 251 participants who initially had no intention of getting vaccinated and completed the follow-up survey; 38% reported becoming vaccinated in the intervening year. Data were analyzed using multilevel logistic regression. Over and above other factors related to vaccination decisions (delay discounting, trust in science), younger participants were more likely to change their decision and become vaccinated a year later, especially if they had higher IU, confirming our predictions. Primary reasons for becoming vaccinated were necessity and seeking protection against the virus. These findings highlight the complex interplay between age, uncertainty, and vaccination decisions, and inform health policies by suggesting the need for tailoring interventions to specific concerns in different age groups.

Cultural determinants of COVID-19 vaccines misinformation in Malawi

This study investigates how global misinformation and local cultural factors shape public perceptions of COVID-19 in Malawi. While misinformation about the pandemic often originates from global sources like the Internet and social media, its impact is influenced by religious and cultural narratives that resonate differently across various demographics, including gender. These ‘cultural determinants’ amplify the influence of misinformation, leading to widespread vaccine hesitancy. The paper draws on findings from a study conducted in the Malawian districts of Zomba, Dowa, and Nkhata Bay. The study reveals how religious prophecies and apocalyptic symbols, such as the ‘666’ mentioned in the biblical Book of Revelation, are used to frame vaccines as malevolent, distorting public understanding and fuelling fears about COVID-19. The role of social media in spreading misinformation is particularly significant, given its ability to quickly disseminate content and engage users as both consumers and creators of information. Despite limited internet access in Malawi, misinformation spreads effectively through offline spaces, where cultural beliefs and mistrust in political leaders further propagate it. This study highlights the need for culturally sensitive public health communication strategies to address the fears and beliefs that drive misinformation and vaccine hesitancy in Malawi and similar contexts. Although misinformation and vaccine hesitancy are global challenges, the study highlights that misinformation in Malawi is culturally specific, localised, and appeals to fears, with distinct resonance across the male-female gender divide.

Vaccinations at home: a new strategy to contain vaccine hesitancy? The experience of ASL Napoli 1 Centro, Italy.

Vaccination coverage are generally geographically variable, even within large cities; furthermore, across target population are embedded difficult-to-reach clusters. To address this issue and improve coverage of mandatory vaccinations, a study group explored bringing vaccination at home as an interventional strategy. In a pilot experience, parents of unvaccinated and under vaccinated children of the 2020 birth cohort living in Naples, Italy were contacted by telephone to offer home administration of vaccinations. A specifically trained team arranged vaccinations visits at home. Coverage rates were evaluated at baseline and one month after the intervention strategy. A significant positive increase in hexavalent vaccine (+1.43%) and measles-mumps-rubella (+1.85%) coverage was registered despite the short duration of the pilot program. Home vaccination turned out to be a medical resource consuming but feasible and successful strategy to increase mandatory vaccinations coverage among the most difficult-to-reach and fragile segments of the pediatric population.

Exploring patterns in online discussions into the lingering impact of COVID-19, two years on

PurposeThe purpose of this study was to explore underlying patterns in the users’ discussions in an online community on the darker effects of COVID-19. Understanding these patterns is critical as they can provide new information in tailoring support to individuals facing specific post-pandemic issues.MethodsTwo methods were used to identify patterns in large volumes of publicly available responses (n = 23,957 posts; ~ 1,061,825 words) from an online community. Qualitatively (using Gioia methodology), 1000 random responses were manually coded by two coders and vetted by an investigator. As it was difficult to manually code such a big dataset, a quantitative approach building a topic model was employed with a language model.ResultsQualitative analyses revealed 20 themes, including mental health (13%), impacts of direct and indirect deaths on socio-economically vulnerable groups (e.g. children and elderly, 10.4%), increasing sociopolitical divide and vaccination debate (6.8%), and work-related issues (e.g. burnout and layoffs, 6%). Topic analyses resulted in similar categories (n = 30), including physical health, loss experiences during COVID-19 and suicide; sociopolitical impact and adaptations in pandemic lifestyle; mental health and vaccination; pandemic restrictions, youth and behavioral expectations; distrust for institutions and resource scarcity; staffing issues and personal crisis; disrupted careers; and childcare challenges and economic shifts.ConclusionAs researchers are harnessing vast amounts of real-time human interaction data to study a variety of public health issues, our study provides insights into the specific challenges that people experienced when it became convenient to share concerns online amid an overloaded healthcare system during the pandemic.

Enhancing COVID-19 Vaccination Awareness and Uptake in the Post-PHEIC Era: A Narrative Review of Physician-Level and System-Level Strategies.

Following the World Health Organization's declaration that the COVID-19 pandemic is no longer a public health emergency of international concern (PHEIC), COVID-19 remains an ongoing threat to human health and healthcare systems. Vaccination plays a crucial role in reducing the disease's incidence, mitigating its severity, and limiting transmission, contributing to long-term public health resilience. However, incomplete vaccination coverage and vaccine hesitancy exist. This narrative review investigates strategies at the system and physician levels aimed at sustaining awareness and uptake of COVID-19 vaccination in a post-PHEIC era. Through an examination of the existing literature, this review explores the effectiveness of diverse approaches utilized by healthcare systems and individual providers. These approaches address every component of the 5C model of vaccine hesitancy: confidence, complacency, constraints/convenience, calculation, and collective responsibility. Physician-level approaches include appropriate message framing, persuasive communication containing safety and personal/social benefit information, sharing of personal stories, creating a safe space for discussion, harnessing co-administration with annual influenza vaccines, and use of decision aids and visual messages. System-level approaches include messaging, mass media for health communication, on-site vaccine availability, pharmacist delivery, healthcare protocol integration, incentives, and chatbot use.

COVID-19 vaccine uptake in a predominantly minoritized cohort hospitalized during the early pandemic in New York City

BackgroundMinoritized communities in the United States have had higher COVID-19 mortality and lower vaccine uptake. The influence of previous SARS-CoV-2 infection, initial disease severity, and persistent symptoms on COVID-19 vaccine uptake in Black and Latinx communities has not been examined. ObjectiveTo investigate whether initial COVID-19 severity, persistent symptoms, and other correlates affected vaccine uptake in a predominantly minoritized cohort hospitalized for COVID-19 during the early pandemic in New York City. DesignIn this historical cohort study, we abstracted electronic health record data on demographics, comorbidities, hospital oxygen requirements, symptoms at 3 and 6 months post-admission, COVID-19 vaccinations through November 2022, and influenza vaccinations during the 2018–2019 through 2021–2022 seasons. Unadjusted and adjusted odds ratios were estimated through logistic regression analyses of correlates of COVID-19 vaccination, on-time vaccination, and boosting. ParticipantsSurvivors among the first 1186 adult patients hospitalized for COVID-19 between March 1 and April 8, 2020 at a large quaternary care medical center in Northern Manhattan. Main MeasuresUptake of at least one COVID-19 vaccine dose, uptake of at least one booster, and on-time vaccination. Key ResultsThe 890 surviving individuals were predominantly Latinx (54%) and Non-Hispanic Black (15%). Most had one or more comorbidities (67%), and received at least one COVID-19 vaccine dose (78%). Among those vaccinated, 57% received at least one booster, and 31% delayed vaccination. 67% experienced persistent symptoms. Multiple logistic regression showed no association between vaccine uptake and disease severity or symptom persistence. However, older age and influenza vaccination during the COVID-19 era were associated with increased vaccination, booster uptake, and on-time vaccination. ConclusionsPinpointing drivers of vaccine uptake and hesitancy is critical to increasing and sustaining COVID-19 vaccination as the field transitions to annual boosters. The association between influenza vaccination and increased vaccine uptake suggests that bundling vaccines for adults may be an effective delivery strategy.

Longitudinal evaluation of COVID-19 vaccine hesitancy in the United States: analysis of the US Census Household Pulse survey

Addressing the challenge of vaccine hesitancy is crucial in managing public health crises like the COVID-19 pandemic. This study leverages the U.S. Census Bureau’s Household Pulse Survey to examine COVID-19 vaccine hesitancy, with a specific focus on the longitudinal tracking of vaccination beliefs and the influence of varying risk perceptions. It investigates how public attitudes towards vaccines evolve, influenced by changing perceptions of COVID-19 risk and vaccine safety. By applying Secondary Risk Theory (SRT), the research elucidates the relationship between different risk perceptions and vaccine hesitancy. We find that threat perception of COVID-19 and lack of trust in the vaccine demonstrate strong predictive value of increased vaccine hesitancy in comparison to other reasons for hesitancy such as access to vaccines, vaccine efficacy beliefs, or perceived secondary risks about vaccine side effects. Respondents with very low primary threat beliefs that COVID-19 is not a threat were 5.65 times more likely (β = 1.732) to intend not to be vaccinated in January 2021, decreasing to 2.70 times more likely to avoid vaccination (β = 0.995) in the December 2021.

Exploring vaccine hesitancy among citizens of the Métis Nation of Ontario: a population-based data linkage study

Objective and ApproachUnderstanding vaccine hesitancy among distinct communities is crucial to ensuring equitable uptake of vaccination. The objective was to examine the influence of psychological antecedents of vaccine uptake, known as the “5Cs”, on COVID-19 vaccination among Métis Nation of Ontario (MNO) citizens. The Métis people are one of three Indigenous peoples in Canada. A population-based online survey was implemented by the MNO, including the short version of the “5C” (confidence, complacency, constraint, calculation, collective responsibility) psychological antecedents of vaccination scale. Census sampling achieved a 39% response rate and respondents were linked to the COVID-19 vaccine database (COVAX) in Ontario (n=4,012). Analyses included logistic regression models (adjusted for sociodemographics) and exploratory latent class analyses. ResultsIn logistic regression models, MNO citizens who were less confident that COVID-19 vaccines were safe (OR=0.04; 95% CI=0.03-0.06) and did not agree vaccination was a collective action to prevent the spread of disease (OR=0.11, 95% CI: 0.07-0.17) had lower odds of being vaccinated. MNO citizens who disagreed the risk of COVID-19 was small (OR=14.87, 95% CI: 9.99-22.13) had a higher odds of being vaccinated. Vaccine hesitancy profiles with (i) lower confidence in availability/safety of COVID-19 vaccines, (ii) lower perceptions about severity of COVID-19 and (iii) higher everyday life constraints/stressors were associated with lower vaccination rates (males, OR: 4.69; CI: 3.18–6.92; females, OR: 4.77, CI: 3.03–7.51) in latent class analyses. Conclusions and ImplicationsMétis-specific analyses enabled a community-driven response, resulting in low vaccine hesitancy and high uptake.

Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis.

The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.

‘It’s really embarrassing […] to ask for help:’ navigating invisible and intersecting inequities in barriers to getting vaccinated

The arrival of COVID-19 vaccines in Canada marked the first time since the H1N1 influenza pandemic that adult vaccination became central in public health discourse, thus evoking feelings and discourse about individuals’ responsibility to get vaccinated. Public health institutions made efforts to ensure vaccines were accessible, and various local organizations worked to fill gaps in accessibility (e.g. vaccine clinics for equity-denied communities). However, despite knowledge of barriers to accessing healthcare, and specifically vaccines, public and health discourses emphasized individual objection as the main barrier to optimal vaccine uptake. This study explored how individuals who identified as a racialized minority or Indigenous person, perceived their personal responsibility to get vaccinated. We gathered perspectives in qualitative interviews (N = 27) when vaccines were first becoming available to adults living in Canada (May-June 2021). Theory about moral regulation, risk governance, and emotion informed our analysis. Findings suggest that individuals engaged in the governance of oneself and others towards getting vaccinated. However, participants also critiqued discourses that hold individuals responsible for accessing vaccines. They identified substantial barriers to accessing vaccines for individuals with fewer resources (e.g. travel time, missing work, childcare). When referencing individuals who do not know how to access information about vaccination, one participant stated, ‘it’s really embarrassing […] to ask for help.’ Feelings of individual responsibility may prevent some people uncertain about vaccines from asking for more information and support. We argue that the focus on vaccine hesitancy without attention to systemic barriers deflects responsibility for making vaccines accessible from centralized institutions to individuals.

SARS-CoV-2 booster vaccination does not worsen glycemia in people with type 1 diabetes using insulin pumps: an observational study.

Despite an increased risk for adverse outcomes from SARS-CoV-2 infection among individuals with type 1 diabetes (T1D), vaccine hesitancy persists due to safety concerns including dysglycemia. The impact of booster vaccination on individuals using automated insulin delivery (AID) systems remains unclear. We used continuous glucose monitoring (CGM) data from 53 individuals with T1D using insulin pump therapy who received their third and/or fourth COVID-19 vaccination. CGM data from the 14 days before and 3 and 7 days after each vaccination were compared. The primary outcome was glucose time in range (TIR) (70-180mg/dL) 3 and 7 days post-vaccination compared with the 14 days prior. Secondary outcomes included other CGM metrics such as time below range (< 70mg/dL), time above range (> 180mg/dL), mean glucose, co-efficient of variation and average total daily insulin. The cohort comprised 53 adults (64% women, 64% AID), totaling 74 vaccination periods (84% Pfizer-BioNTech boosters), mean ± SD age 40.0 ± 15.9 years, duration of diabetes 26.0 ± 15.4 years. There was no significant difference between pre-vaccination TIR (61.0%±18.5) versus 3 (60.5%±22.8) and 7 days post-vaccination (60.2%±21.8; p = 0.79). Level 1 hypoglycemia, time in range 54-69mg/dL, was lower 3 (1.1%±1.7) and 7 days post-vaccination (1.1%±1.6), compared with 14 days pre-vaccination (1.4%±1.4; p = 0.021). The study provides evidence that SARS-CoV-2 booster vaccination does not acutely worsen glycemia in people with T1D receiving insulin pump therapy.

Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study.

In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners. The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting. We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients. Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada). Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data. Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care. Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.

Pertussis Epidemiology in Children: The Role of Maternal Immunization.

In the last twelve months, a significant global increase in pertussis cases has been observed, particularly among infants under three months of age. This age group is at the highest risk for severe disease, hospitalization, and death. Maternal immunization with the Tdap vaccine during pregnancy has been recommended to protect newborns by transferring maternal antibodies transplacentally. This review examines the current epidemiology of pertussis, the importance of preventing it in young children, and the effectiveness of maternal immunization. Despite the proven benefits of maternal vaccination, which has been found effective in pertussis prevention in up to 90% of cases, coverage remains suboptimal in many countries. Factors contributing to low vaccination rates include vaccine hesitancy due to low trust in health authority assessments, safety concerns, practical barriers to vaccine access, and the impact of the COVID-19 pandemic, which disrupted routine vaccination services. The recent increase in pertussis cases may also be influenced by the natural cyclic nature of the disease, increased Bordetella pertussis (Bp) activity in older children and adults, and the genetic divergence of circulating Bp strains from vaccine antigens. Given the high efficacy of maternal vaccination in preventing pertussis in infants, increasing coverage rates is crucial. Efforts to improve vaccine uptake should address barriers to access and vaccine hesitancy, ensuring consistent immune protection for the youngest and most vulnerable populations. Enhanced maternal vaccination could significantly reduce the incidence of whooping cough in infants, decreasing related hospitalizations and deaths.

Trust in government, social media and willingness to vaccinate

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust.

Social Media and Vaccine Intention: The Case of Kuwait

Purpose: The COVID-19 pandemic has underscored our heavy reliance on social media platforms for primary information. Misinformation related to the pandemic has significantly affected behaviors related to vaccine hesitancy and overall business confidence. This study uses the extended Information Motivation Behavior (IMB) model to examine the impact of pandemic-era social media usage on vaccine hesitancy and trust in e-commerce.Study design/methodology/approach: Structural equation modeling is used to assess the extended IMB model. Sample and data: Online survey data from a diverse cross-section of the Kuwaiti population during the pandemic's peak. Results: Findings highlight the substantial influence of factors such as knowledge, motivation, observational learning-driven motivation, behavioral skills, social media usage, engagement, and consumption on vaccine willingness. This, in turn, significantly impacts trust in e-commerce. Notably, social media use, consumption, and engagement have adverse effects on health behavior, with observational learning-driven motivation being the most influential.Originality/value: This study is one of the few empirical studies that examine and test the impact of e-commerce on the Kuwaiti population during and after the COVID-19 pandemic. The results of this study display the shift in consumer behavior during the pandemic.Research limitations/implications: The study emphasizes the importance of accurate vaccine information dissemination on social media to counter misinformation, ultimately fostering an informed society and contributing to e-commerce growth.

Exploring the feasibility and acceptability of community paramedicine programs in achieving vaccination equity: a qualitative study

BackgroundMobile Integrated Health-Community Paramedicine (MIH-CP) is a novel approach that may reduce the rural-urban disparity in vaccination uptake in the United States. MIH-CP providers, as physician extenders, offer clinical follow-up and wrap-around services in homes and communities, uniquely positioning them as trusted messengers and vaccine providers. This study explores stakeholder perspectives on feasibility and acceptability of community paramedicine vaccination programs.MethodsWe conducted semi-structured qualitative interviews with leaders of paramedicine agencies with MIH-CP, without MIH-CP, and state/regional leaders in Indiana. Interviews were audio recorded, transcribed verbatim, and analyzed using content analysis.ResultsWe interviewed 24 individuals who represented EMS organizations with MIH-CP programs (MIH-CP; n = 10), EMS organizations without MIH-CP programs (non-MIH-CP; n = 9), and state/regional administrators (SRA; n = 5). Overall, the sample included professionals with an average of 19.6 years in the field (range: 1–42 years). Approximately 75% (n = 14) were male, and all identified as non-Hispanic white. MIH-CPs reported they initiated a vaccine program to reach underserved areas, operating as a health department extension. Some MIH-CPs integrated existing services, such as food banks, with vaccine clinics, while other MIH-CPs focused on providing vaccinations as standalone initiatives. Key barriers to vaccination program initiation included funding and vaccinations being a low priority for MIH-CP programs. However, participants reported support for vaccine programs, particularly as they provided an opportunity to alleviate health disparities and improve community health. MIH-CPs reported low vaccine hesitancy in the community when community paramedics administered vaccines. Non-CP agencies expressed interest in launching vaccine programs if there is clear guidance, sustainable funding, and adequate personnel.ConclusionsOur study provides important context on the feasibility and acceptability of implementing an MIH-CP program. Findings offer valuable insights into reducing health disparities seen in vaccine uptake through community paramedics, a novel and innovative approach to reduce health disparities in rural communities.

Exploring the Views of Barbers and Stylists on the Acceptability of Delivering Community-Based Interventions to Promote COVID-19 Testing and Vaccination in South Carolina.

The COVID-19 pandemic has underscored the need for effective community-based interventions to promote disease prevention and reach high-risk, underserved communities. Trusted community leaders like barbers and stylists may serve as effective conduits for intervention implementation. This study aimed to explore the perceived acceptability of an intervention to promote COVID-19 testing and vaccination delivered by barbers in South Carolina. We conducted exploratory in-depth interviews to ascertain barbers' and stylists' perceptions and identify potential barriers and facilitators. Data analysis used a deductive coding approach to identify themes and was guided by the Theoretical Framework of Acceptability. Sixteen participants were interviewed. Participants expressed positive reactions towards the interventions. Acceptability was influenced by strong trust relationships with clients, perceived community influence, self-efficacy in providing the intervention, and a shared sense of responsibility for community health. However, potential barriers included declining public concern about COVID-19, vaccine hesitancy, and limited COVID-19 knowledge among barbers and stylists. Participants emphasized the need for training and incentives for effective and sustained intervention delivery. Barbers and stylists are well-positioned to promote COVID-19 testing and vaccination due to their trusted roles and community influence. Given the complacency from the waning perceived COVID-19 threat and the historical mistrust in health interventions, vaccine hesitancy must be addressed through supportive communication strategies.

Challenges and Solutions to the Recurrent Measles Outbreak in Somalia

This study aims to address the persistent challenge of recurrent measles outbreaks inSomalia by providing an analysis of underlying issues and proposing evidence-basedsolutions. Measles, a highly contagious viral infection, continues to pose significantthreat to public health worldwide, with Somalia facing unique challenges due to itscomplex geographical and sociopolitical landscape. The country’s history of conflict,fragile healthcare infrastructure, and limited access to basic healthcare services havehindered efforts to control preventable diseases like measles.These recurrent outbreaks do not only have immediate consequences on public healthbut also exacerbate an already precarious situation in Somalia, leading to substantialsocioeconomic impacts as families grapple with the dual burden of disease and strainon livelihoods. The primary objective of this communication is to analyze the challengescontributing to the persistence of measles outbreaks in Somalia and propose evidencebasedsolutions.To achieve this goal, the subsequent sections of this brief delve into the specificchallenges facing Somalia in its battle against recurrent measles outbreaks. Thesechallenges encompass issues such as vaccine access, vaccine hesitancy, coveragedisparities, fragility of healthcare infrastructure, obstacles in community engagement,and limitations in disease surveillance and response.Understanding these intricate factors is crucial for designing targeted interventionsthat not only mitigate the immediate impact of measles outbreaks but also establish afoundation for long-term prevention.