High Vaccine Uptake Research Articles

The potential role of perceived neighborhood social cohesion on COVID-19 vaccination uptake among individuals aged 50 and older: Results from the Korean Community Health Survey.

The COVID-19 pandemic highlighted the critical importance of vaccination in controlling infectious diseases. While previous research has identified social cohesion as a potential facilitator of health behaviors, empirical studies exploring its direct impact on COVID-19 vaccination rates, especially across different age groups, remain limited. This cross-sectional study utilized data from the 2021 Korean Community Health Survey, a nationally representative survey conducted in South Korea. The analysis focused on adults aged 50 and older, categorizing them into two age groups (50-64 and ≥65). We investigated the association between perceived neighborhood social cohesion and COVID-19 vaccination status, controlling for socio-economic status, health behaviors, and concerns related to COVID-19. Statistical analysis was conducted using complex sample multiple logistic regression to adjust for potential confounders. The study included 135,352 participants, with an analysis showing that in the age group ≥65, higher levels of perceived neighborhood social cohesion were significantly associated with increased vaccination uptake (aOR for trust between neighbors: 1.200, 95% CI: 1.058-1.362; aOR for mutual assistance among neighbors: 1.491, 95% CI: 1.312-1.695). Interestingly, these associations were not significant in the 50-64 age group. Additionally, satisfaction with healthcare services was associated with higher vaccination uptake in both age groups (aOR: 1.106, 95% CI: 1.004-1.219 for 50-64; aOR: 1.306, 95% CI: 1.160-1.471 for ≥65). Our findings suggest that perceived neighborhood social cohesion plays a crucial role in influencing COVID-19 vaccination uptake among older adults, particularly those aged 65 and above. These results indicate that health policies aimed at enhancing social cohesion may effectively improve vaccination rates, especially among the elderly. Future research should explore the impact of social cohesion on other age groups and assess the causal relationships in longitudinal studies.

Drivers of COVID-19 vaccine uptake among rural populations in Madagascar: a cross-sectional study

BackgroundThe WHO set the global immunisation threshold for COVID-19 at 70% to achieve worldwide protection against the disease. To date, global COVID-19 vaccine coverage is still below this threshold, in particular in several sub-Saharan African (SSA) countries, such as Madagascar. While factors influencing COVID-19 vaccine hesitancy have been widely explored in the past few years, research on drivers of COVID-19 vaccine uptake remains scarce. This study aimed at investigating drivers associated with COVID-19 vaccine uptake in the Boeny region of Madagascar.MethodsThe study used a cross-sectional survey design to collect data on drivers of vaccine uptake from a sample of adults recruited from 12 healthcare facilities between November 2022 and February 2023. Relative and absolute frequencies were used to summarize participants’ characteristics. Prevalence ratios were estimated by Poisson regression to identify and compare sociodemographic and motivational drivers of vaccine uptake among those who were willing to get vaccinated against COVID-19 with those who had already been vaccinated.ResultsA total of 928 participants aged between 18 and 76 years were included in the study. Among those recruited, 44.9% (n = 417) had already been vaccinated and 55.1% (n = 511) were willing to receive their first dose of COVID-19 vaccine on the day of the interview. The proportions of those respondents who live in urban areas (56.5% vs. 43.8%) and who have high school or university education (46.6% vs. 35.8%) were higher for the uptake group, whereas the proportion of employed respondents (66.3% vs. 56.5%) was higher among those willing to get vaccinated. Vaccine being free of charge (aPR = 1.77 [CI 95%: 1.45–2.17]) and being able to travel again (aPR = 1.61 [CI 95%: 1.30–1.98]) were the drivers most strongly associated with higher vaccine uptake after adjustment for sociodemographic factors.ConclusionsThis study shows that actual COVID-19 vaccine uptake is influenced by a different set of factors than willingness to get vaccinated. Taking this difference in drivers into account can inform more tailored vaccination strategies to increase worldwide coverage.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic.

During the COVID-19 pandemic, hypertensive patients had increased infection and healthcare disruption in many low- and middle-income countries (LMICs) with limited vaccine access. The objective of this report is to describe COVID-19 experiences and vaccination uptake among hypertensive patients in Colombia and Jamaica. A cross-sectional study of patients with hypertension was conducted in primary care clinics in both countries between 2021 and 2022. Trained interviewers used a telephone-administered questionnaire to assess COVID-19 experiences (infection, vaccination, and healthcare access). A total of 576 patients (68.5% female, mean age: 67.5 years) participated. Health service disruption affecting access to care was low (<10%). Compared to Jamaica, more participants from Colombia reported testing positive for COVID-19, having family members or friends testing positive, losing family members or friends due to COVID-19, and being vaccinated. In logistic regression models, adjusted for age, sex, education, and rural/urban clinic status, fear of COVID-19 (OR 2.7, 95% CI: 1.2-6.1) and residence in Colombia (OR 5.9, 95% CI: 2.4-14.6) were associated with higher vaccination uptake. Disparities in access to COVID-19 testing and diagnosis may have influenced these country differences including fear of COVID-19 and vaccine uptake. Other factors need to be better understood to prepare for future pandemic responses.

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study

ObjectivesMobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies. Study designThe study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022. MethodsPrisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models. ResultsThe MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare. ConclusionsThe high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

Influences of HPV disease perceptions, vaccine accessibility, and information exposure on social media on HPV vaccination uptake among 11,678 mothers with daughters aged 9–17 years in China: a cross-sectional study

BackgroundMothers play a crucial role in influencing their daughters’ HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels.MethodsFrom July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data.ResultsAmong 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake.ConclusionsThese findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England

BackgroundOutreach clinics were part of efforts to maximise uptake in COVID-19 vaccination.MethodsWe used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed.Results50% of 288,473 exposed citizens were white British, and 71% were aged 0–49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was − 0.12% (95% CI: -0.90%, 0.66%); by age group it was − 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%).ConclusionsLiving within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

Factors associated with COVID-19 vaccine uptake among South African health care workers

BackgroundIdentifying factors associated with vaccine uptake among health care workers (HCWs) remains crucial to generating evidence aimed at guiding national COVID-19 vaccination and future infectious disease outbreak strategies. This study aimed to elucidate these factors, focusing on the interplay between socio-demographic, health, knowledge, beliefs and attitudinal indicators. MethodsThis was a cross-sectional online survey administered to HCWs across South Africa between August and October 2022. Bivariate and Multivariate logistic regressions identified associations between COVID-19 vaccine uptake and demographics, occupational characteristics, general knowledge of and attitudes towards vaccination, perceived COVID-19 risk and perceived importance of COVID-19 vaccine attributes. ResultsAnalysis revealed high vaccine uptake rates among the sample of 5564 HCWs, with 87.6% of the sample vaccinated at the time of the study. Demographic measures significantly associated with vaccine uptake were age (P-value = 0.001), race (P-value = 0.021), religion (P-value = 0.004), and having a chronic illness (P-value <0.001). Belief and attitude measures significantly associated with vaccine uptake included: need for vaccines (P-value <0.001), perceived risk of infection (P-value = 0.001), perceived patient risk (P-value <0.001), and perceived vaccine knowledge (P-value <0.001). Multivariate analysis revealed that HCWs who listed their religion as African Spirituality (OR = 0.4; 95% CI = 0.2–0.7; P-value = 0.002) and had any occupation other than nurse or doctor (OR = 0.6; 95% CI = 0.4–0.8; P-value <0.001), were less likely to vaccinate, while HCWs who had a chronic condition (OR = 1.5; 95% CI = 1.2–2.0; P-value <0.001) were more likely to have been vaccinated. ConclusionThis study provides useful insights into the factors associated with and possibly driving COVID-19 vaccine uptake among HCWs in South Africa. These results add to a limited body of knowledge on contextual dynamics associated with vaccination programmes in Africa.

Minding the margins: Evaluating the impact of COVID-19 among Latinx and Black communities with optimal qualitative serological assessment tools.

COVID-19 disproportionately affected minorities, while research barriers to engage underserved communities persist. Serological studies reveal infection and vaccination histories within these communities, however lack of consensus on downstream evaluation methods impede meta-analyses and dampen the broader public health impact. To reveal the impact of COVID-19 and vaccine uptake among diverse communities and to develop rigorous serological downstream evaluation methods, we engaged racial and ethnic minorities in Massachusetts in a cross-sectional study (April-July 2022), screened blood and saliva for SARS-CoV-2 and human endemic coronavirus (hCoV) antibodies by bead-based multiplex assay and point-of-care (POC) test and developed across-plate normalization and classification boundary methods for optimal qualitative serological assessments. Among 290 participants, 91.4% reported receiving at least one dose of a COVID-19 vaccine, while 41.7% reported past SARS-CoV-2 infections, which was confirmed by POC- and multiplex-based saliva and blood IgG seroprevalences. We found significant differences in antigen-specific IgA and IgG antibody outcomes and indication of cross-reactivity with hCoV OC43. Finally, 26.5% of participants reported lingering COVID-19 symptoms, mostly middle-aged Latinas. Hence, prolonged COVID-19 symptoms were common among our underserved population and require public health attention, despite high COVID-19 vaccine uptake. Saliva served as a less-invasive sample-type for IgG-based serosurveys and hCoV cross-reactivity needed to be evaluated for reliable SARS-CoV-2 serosurvey results. The use of the developed rigorous downstream qualitative serological assessment methods will help standardize serosurvey outcomes and meta-analyses for future serosurveys beyond SARS-CoV-2.

Case-cohort design as an efficient approach to evaluating COVID-19 vaccine effectiveness, waning, heterologous immune effect and optimal dosing interval

Though widely applied in other epidemiological fields, the case-cohort study design has seen little application in the field of vaccinology. Case-cohort studies use probabilistic sampling and reweighting to draw inferences about effects (in this case vaccine efficacy) at the population level in an efficient manner. The SARS-CoV-2 pandemic was met with high vaccine uptake, and high rates of population testing prior to the emergence of Omicron variants of concern, in Ontario, Canada, providing an ideal environment for application of case-cohort methodology. We combined a population-based case line list and vaccination database for the province of Ontario between December 2020 and October 2021. Risk of infection after vaccination was evaluated in all laboratory-confirmed vaccinated SARS-CoV-2 cases, and a 2 % sample of vaccinated controls, evaluated using survival analytic methods, including construction of Cox proportional hazards models. Vaccination status was treated as a time-varying covariate. First and second doses of SARS-CoV-2 vaccine markedly reduced risk of infection (first dose efficacy 68 %, 95 % CI 67 %–69 %; second dose efficacy 88 %, 95 % CI 87–88 %). In multivariable models, extended dosing intervals were associated with lowest risk of breakthrough infection (HR for redosing 0.64 (95 % CI 0.61–0.67) at 6–8 weeks). Heterologous vaccine schedules that mixed viral vector vaccine first doses with mRNA second doses were significantly more effective than mRNA only vaccines. Risk of infection largely vanished during the time period 4–6 months after the second vaccine dose, but rose markedly thereafter. We conclude that a case-cohort design provided an efficient means to identify strong protective effects associated with SARS-CoV-2 vaccination in real time, and also served to quantify the timing and magnitude of infection breakthrough risk in the same cohort. Heterologous vaccination and extended dosing intervals improved the durability of immune response.

Pertussis notifications decline in Australia during COVID-19 non-pharmaceutical interventions, 2020-2021.

Following implementation of coronavirus diseases 2019 (COVID-19) non-pharmaceutical interventions (NPIs) in early 2020, declines in the incidence of other respiratory pathogens have been reported. This study aimed to assess the impact of these interventions on pertussis notifications in Australia. We compared monthly national notification rates for pertussis during the first two years of the COVID-19 pandemic (2020 and 2021) to those during the three pre-pandemic years (2017 to 2019). Incidence rate ratios (IRR) by age group and jurisdiction were calculated for 2020 and 2021 compared to the mean prepandemic annual notification rate. A substantial progressive decline in pertussis notifications was seen across all age groups, with all-age notification rates more than 40% lower than the pre-pandemic period in all jurisdictions in 2020, and more than 80% lower in 2021. Notification rates decreased more slowly from a lower baseline in Victoria than in other states and territories, despite the stricter, more sustained NPIs implemented in Victoria. The significant decrease in pertussis notifications across all jurisdictions and age groups has likely resulted in reduced infection-acquired immunity, making maintenance of high vaccine uptake, particularly among pregnant women and young infants, of key importance.

Sex and COVID-19 vaccination uptake and intention in the Democratic Republic of Congo, Nigeria, Senegal, and Uganda

The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the uptake of COVID-19 vaccines. However, little is documented about how sex differences could have impacted COVID-19 vaccination. We conducted a multi-country cross-sectional study to assess the sex differences in COVID-19 vaccine uptake and intention to vaccinate in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This study involved analysis of data from mobile surveys conducted between March and June 2022 among nationally constituted samples of adults in each country. Bivariate and multivariable logistic regression models were run. The self-reported uptake of COVID-19 vaccines was not significantly different between males and females (p = 0.47), while the intention to vaccinate was significantly higher among males (p = 0.008). Among males, obtaining COVID-19 information from health workers, testing for COVID-19, and having high trust in the Ministry of Health were associated with higher vaccination uptake. Among females, having high trust in the government was associated with higher vaccination uptake. For intention to vaccinate, males who resided in semi-urban areas and females who resided in rural areas had significantly higher vaccination intention compared to their counterparts in urban areas. Other factors positively associated with vaccination intention among males were trust in the World Health Organization and perceived truthfulness of institutions, while males from households with a higher socio-economic index and those who had declined a vaccine before had a lower vaccine intention. Overall, the factors differentiating vaccine uptake and intention to vaccinate among males and females were mostly related to trust in government institutions, perceived truthfulness of institutions, and respondent's residence. These factors are key in guiding the tailoring of interventions to increase COVID-19 vaccine uptake in sub-Saharan Africa and similar contexts.

COVID-19 vaccination in pregnancy: A quantitative and qualitative analysis of the effect of strong public health messaging in an Australian cohort.

SARS-CoV-2 infection in pregnancy predisposes women and their offspring to adverse health outcomes, while internationally reported rates of vaccination uptake remain low. Our study objective was to quantify the uptake of COVID-19 vaccination in pregnant women, and to assess their attitudes toward vaccination in pregnancy with both quantitative and qualitative analyses. This is a prospective, cross-sectional survey at Australia's largest quaternary level maternity centre. A total of 351 pregnant women, at 6-42 weeks gestation receiving antenatal care at our hospital, completed an online voluntary, anonymous, 17 question survey. This was conducted during a five-week period in November to December 2021. The main outcome measures were demographic data, prior SARS-CoV-2 infection and COVID-19 vaccination status, knowledge and attitudes surrounding COVID-19 disease and vaccination in pregnancy. High rates of COVID-19 vaccination were observed in this pregnant population. Of the 351 respondents, 82% had received at least one dose of the COVID 19-vaccination. This increased compared to estimates of 15% in June 2021 which were obtained from the hospital's electronic health record. Our survey demonstrates that a strong public health campaign with clear messaging regarding the beneficial effects of COVID-19 vaccination in pregnancy can lead to high vaccination uptake rates.

Importance of social inequalities to contact patterns, vaccine uptake, and epidemic dynamics.

Individuals' socio-demographic and economic characteristics crucially shape the spread of an epidemic by largely determining the exposure level to the virus and the severity of the disease for those who got infected. While the complex interplay between individual characteristics and epidemic dynamics is widely recognised, traditional mathematical models often overlook these factors. In this study, we examine two important aspects of human behaviour relevant to epidemics: contact patterns and vaccination uptake. Using data collected during the COVID-19 pandemic in Hungary, we first identify the dimensions along which individuals exhibit the greatest variation in their contact patterns and vaccination uptake. We find that generally higher socio-economic groups of the population have a higher number of contacts and a higher vaccination uptake with respect to disadvantaged groups. Subsequently, we propose a data-driven epidemiological model that incorporates these behavioural differences. Finally, we apply our model to analyse the fourth wave of COVID-19 in Hungary, providing valuable insights into real-world scenarios. By bridging the gap between individual characteristics and epidemic spread, our research contributes to a more comprehensive understanding of disease dynamics and informs effective public health strategies.

Insufficient vaccine coverage and vaccine hesitancy in people living with HIV: A prospective study in outpatient clinics in the Paris region

Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region.A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records.A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41–58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3–81.8 %), 62.7 % for hepatitis A (57.3–67.9 %), 61.2 % for pneumococcal vaccines (55.8–66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0–61.9 %), 44.7 % for seasonal influenza (39.3–50.1 %), 31.4 % for measles/mumps/rubella (26.4–36.6 %) and 38.5 % for meningococcal vaccine (13.9–68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9–75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed.The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed.

Uptake and Determinants of Tetanus Vaccination among Female Clinical Medical Students in North-Western Nigeria

Background and Aim: Neonatal and maternal tetanus have remained endemic in tropical countries of Asia and Africa, with high fatality. Vaccination of women of childbearing age is the main strategy for their prevention/elimination. However, the uptake of these vaccines among these women has remained dismally low in these parts of the world. This study looked at the uptake and determinants of tetanus vaccination among the female clinical medical students of Bayero University, Kano, purposely looking at the interplay between knowledge and other factors on vaccine uptake. Materials and Methods: This was a cross-sectional study of female medical students aged 15–45 years, selected using probability proportionate to size and simple random sampling. The required information was collected using a validated semi-structured questionnaire. The data were analyzed using the Statistical Product and Service Solutions (SPSS) for Windows version 23. Prevalences of tetanus vaccination were calculated. The presence of a statistically significant difference in prevalence and other characteristics of the study groups were determined using appropriate tests. P &lt;0.05 was considered statistically significant. Results: The participants were 140 with the mean age and mean knowledge scores of 23.96 (±2.74) years and 6.61 (±2.47), respectively. Most of them (59.3%) had good knowledge score (&gt;7). The prevalence of tetanus toxoid (TT)1 and TT2 was 20.7% and 17.1%, respectively. Being married, ever pregnant, and higher level of study were significantly associated with being vaccinated (χ2 / P =59.093/P &lt;0.001, P = 65.011/P &lt;0.001, and P = 9.860/P =0.020, respectively). Conclusions: Despite the good knowledge of the vaccination, the uptake of TT vaccination among clinical female students was poor. Factors significantly associated with higher vaccine uptake were marital status, age of the participants, and their class of study.

High COVID-19 vaccine uptake following initial hesitancy among people in Australia who inject drugs

BackgroundPrevious studies have reported high COVID-19 vaccine hesitancy among people who inject drugs. We aimed to examine COVID-19 vaccine coverage, motivations and barriers to vaccination, and factors associated with uptake among this population in Australia, 1.5 years after vaccine rollout commenced. MethodsIn June-July 2022, 868 people (66.0 % male, mean age 45.6 years) who regularly inject drugs and reside in an Australian capital city reported the number of COVID-19 vaccine doses they had received and their primary motivation (if vaccinated) or barrier (if unvaccinated) to receive the vaccine. We compared vaccine uptake to Australian population estimates and used logistic regression to identify factors associated with ≥ 2 dose and ≥ 3 dose uptake. ResultsOverall, 84.1 % (n = 730) had received at least one COVID-19 vaccine dose, 79.6 % (n = 691) had received ≥ 2 doses, and 46.1 % (n = 400) had received ≥ 3 doses. Participants were less likely to be vaccinated than the Australian general population (prevalence ratio: 0.82, 95 % confidence interval [CI]: 0.76–0.88). Key motivations to receive the vaccine were to protect oneself or others from COVID-19, while barriers pertained to vaccine or government distrust. Opioid agonist treatment (adjusted odds ratio [aOR]: 2.49, 95 % CI: 1.44–4.42), current seasonal influenza vaccine uptake (aOR: 6.76, 95 % CI: 3.18–16.75), and stable housing (aOR: 1.58, 95 % CI: 1.02–2.80) were associated with receipt of at least two vaccine doses. Participants aged ≥ 40 years (versus < 40 years; aOR: 1.66, 95 % CI: 1.10–2.53) or who reported a chronic health condition (aOR: 1.71, 95 % CI: 1.18–2.47) had higher odds of receiving at least three vaccine doses. ConclusionWe observed higher COVID-19 vaccine uptake than expected given previous studies of vaccine acceptability among people who inject drugs. However, it was lower than the general population. People who inject drugs and reside in unstable housing are a subpopulation that require support to increase vaccine uptake.

COVID-19 impacts and inequities among underserved communities with diabetes

BackgroundPeople with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes. MethodsFrom November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher’s Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally. ResultsOverall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p <.001). Participants reported pandemic-related healthcare changes (62 %) and higher costs of diabetes medications (41 %). Income loss was more frequent in Florida (76 %; p <.001). NHBs most frequently reported “severe” income loss (26.4 %; p =.0124). Loss of health insurance was more common among NHBs (13.3 %; p =.0416) and in Florida (9.7 %; p =.039). COVID-19 anxiety was highest among NHBs and Hispanics (IQR = [0.0, 3.0]; p =.0232) and in Florida (IQR = [0.0, 2.0]; p =.0435). ConclusionsUnderserved communities with diabetes had high COVID-19 vaccine uptake but experienced significant COVID-19-related physical, psychosocial, and financial impacts. NHBs and those in Florida had worse outcomes than other racial/ethnic groups and those in California. Further research, interventions, and policy changes are needed to promote health equity for this population.

Highlighting models of Indigenous leadership and self-governance for COVID-19 vaccination programmes

The COVID-19 pandemic has disproportionately impacted Indigenous populations worldwide placing much importance on rapid and equitable vaccination. Nevertheless, many Indigenous communities have reported high vaccine hesitancy and low COVID-19 vaccine uptake. This may be attributed to various factors, including a lack of support for Indigenous leadership efforts to protect their communities and the pervasive infodemic targeting First Nations Peoples. In August 2022, we hosted an international symposium to bring together Indigenous and non-Indigenous community leaders, clinicians, and researchers to discuss pandemic experiences and lessons learnt. This commentary highlights examples of harnessing Indigenous leadership and self-governance to design and deliver tailored community-based and culturally appropriate COVID-19 vaccination programmes that improved vaccine uptake in Australia and Canada. These case studies demonstrate that Indigenous social-governance systems need to be valued, respected, and upheld if we are to make meaningful efforts to address health inequities among Indigenous communities during future pandemics.

Attitudes towards COVID-19 Vaccination in Adults with Haematological Malignancies

Introduction: Despite people with haematological malignancies being particularly vulnerable to severe COVID-19 infection and complications, vaccine hesitancy may be a barrier to optimal vaccination. This study explored attitudes towards COVID-19 vaccination in people with haematological malignancies. Methods: People with haematological malignancies at nine Australian health services were surveyed between June and October 2021. Sociodemographic and clinical characteristics were collected. Attitudes towards COVID-19 vaccination were explored using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Open-ended comments were qualitatively analysed. Results: A total of 869 people with haematological malignancies (mean age 64.2 years, 43.6% female) participated. Most participants (85.3%) reported that they had received at least one COVID-19 vaccine dose. Participants who were younger, spoke English as a non-dominant language, and had a shorter time since diagnosis were less likely to be vaccinated. Those who were female or spoke English as their non-dominant language reported greater vaccine side-effect concerns. Younger participants reported greater concerns about the vaccine impacting their treatment. Conclusion: People with haematological malignancies reported high vaccine uptake; however, targeted education for specific participant groups may address vaccine hesitancy concerns, given the need for COVID-19 vaccine boosters.

Assortative mixing of opinions about COVID-19 vaccination in personal networks

Many countries worldwide had difficulties reaching a sufficiently high vaccination uptake during the COVID-19 pandemic. Given this context, we collected data from a panel of 30,000 individuals, which were representative of the population of Romania (a country in Eastern Europe with a low 42.6% vaccination rate) to determine whether people are more likely to be connected to peers displaying similar opinions about COVID-19 vaccination. We extracted 443 personal networks, amounting to 4430 alters. We estimated multilevel logistic regression models with random-ego-level intercepts to predict individual opinions about COVID-19 vaccination. Our evidence indicates positive opinions about the COVID-19 vaccination cluster. Namely, the likelihood of having a positive opinion about COVID-19 vaccination increases when peers have, on average, a more positive attitude than the rest of the nodes in the network (OR 1.31, p < 0.001). We also found that individuals with higher education and age are more likely to hold a positive opinion about COVID-19 vaccination. With the given empirical data, our study cannot reveal whether this assortative mixing of opinions is due to social influence or social selection. However, it may nevertheless have implications for public health interventions, especially in countries that strive to reach higher uptake rates. Understanding opinions about vaccination can act as an early warning system for potential outbreaks, inform predictions about vaccination uptake, or help supply chain management for vaccine distribution.