Increase Vaccine Uptake Research Articles

Using a computational cognitive model to simulate the effects of personal and social network experiences on seasonal influenza vaccination decisions

IntroductionSeasonal influenza poses significant societal costs, including illness, mortality, and reduced work productivity. Vaccination remains the most effective strategy for preventing the disease, yet vaccination rates in the United States fall below 50% for adults. Understanding the factors influencing vaccination decisions is crucial for designing interventions to improve uptake. This study investigates how personal experiences and the experiences of social contacts affect individual decisions to get vaccinated against influenza.MethodsA multi-year longitudinal survey study was conducted to examine the impact of personal and social network experiences on vaccination decisions. Participants' vaccination behaviors and experiences with influenza were tracked over time. To model these influences, we developed a memory-based vaccination decision model using the Adaptive Control of Thought – Rational (ACT-R) integrated cognitive architecture, which incorporates cognitive processes associated with memory and decision-making.ResultsThe survey results demonstrated that both personal experiences with influenza and the experiences of close social contacts significantly influenced vaccination decisions. The memory-based model, built within the ACT-R framework, effectively captured these effects, providing a computational representation of how personal and social factors contribute to vaccination behaviors.DiscussionThe findings suggest that personal and social experiences play a critical role in shaping vaccination decisions, which can inform the development of targeted interventions to increase vaccination uptake. By incorporating cognitive processes into the model, we identified potential strategies to enhance vaccine promotion efforts, such as recalling past experiences with illness to motivate individuals to get vaccinated.

Influence of Knowledge and Cultural Beliefs on Attitudes Toward HPV Vaccination Among Israeli Nurses and Nursing Students: Implications for Vaccine Advocacy

Background: Human papillomavirus (HPV) poses a significant health burden, yet the vaccine which successfully prevents HPV and its associated cancers remains underutilized. Nurses play a crucial role in patient education and advocacy for HPV vaccination. This study explores how knowledge, along with cultural, religious, and social beliefs, shapes the attitudes of Israeli nurses and nursing students toward the HPV vaccine and their advocacy efforts. Methods: A cross-sectional study was conducted from August 2023 to January 2024 using an anonymous online questionnaire distributed via Facebook groups targeting Israeli nurses and nursing students. The questionnaire assessed demographic data, HPV-related knowledge, and attitudes toward HPV vaccination. Results: The study included 458 participants (229 nurses and 229 nursing students). Significant knowledge gaps were found, with 52% of participants incorrectly believing that the vaccine can cure existing infections and 47% mistakenly believing that it is administered in a single dose. Logistic regression revealed that nurses working in community settings were more likely to have positive attitudes toward HPV vaccination (OR = 2.98, 95% CI: 1.84–4.85). Higher levels of HPV-related knowledge (OR = 3.35, 95% CI: 2.10–5.35) and secular or traditional religious affiliations (OR = 2.45, 95% CI: 1.52–3.97) were strongly associated with positive attitudes toward and advocacy for the vaccine. Conclusions: Targeted educational programs addressing knowledge gaps, especially those tailored to Israel’s cultural and religious diversity, are crucial for empowering nurses and nursing students as advocates for HPV vaccination. Enhancing their understanding of HPV can increase vaccine uptake, reduce the incidence of HPV-related diseases, and strengthen public health initiatives in Israel.

Variations in COVID-19 vaccine hesitancy over time: a serial cross-sectional study in five West African countries

ObjectivesThis study aims to identify the factors influencing vaccine hesitancy, willingness and its variation over time in order to inform more responsive strategies for increasing vaccination uptake. The specific objectives...

EMSIG: Uncovering Factors Influencing COVID-19 Vaccination Across Different Subgroups Characterized by Embedding-Based Spatial Information Gain

Background/Objectives: COVID-19 and its variants continue to pose significant threats to public health, with considerable uncertainty surrounding their impact. As of September 2024, the total number of deaths reached 8.8 million worldwide. Vaccination remains the most effective strategy for preventing COVID-19. However, vaccination rates in the Deep South, U.S., are notably lower than the national average due to various factors. Methods: To address this challenge, we developed the Embedding-based Spatial Information Gain (EMSIG) method, an innovative tool using machine learning techniques for subgroup modeling. EMSIG helps identify subgroups where participants share similar perceptions but exhibit high variance in COVID-19 vaccine doses. It introduces spatial information gain (SIG) to screen regions of interest (ROI) subgroups and reveals their specific concerns. Results: We analyzed survey data from 1020 participants in Alabama. EMSIG identified 16 factors encompassing COVID-19 hesitancy and trust in medical doctors, pharmacists, and public health authorities and revealed four distinct ROI subgroups. The five factors, including COVID-19 perceived detriment, fear, skepticism, side effects related to COVID-19, and communication with pharmacists, were commonly shared across at least three subgroups. A subgroup primarily composed of Democrats with a high flu-shot rate expressed concerns about pharmacist communication, government fairness, and responsibility. Another subgroup, characterized by older, white Republicans with a relatively low flu-shot rate, expressed concerns about doctor trust and the intelligence of public health authorities. Conclusions: EMSIG enhances our understanding of specific concerns across different demographics, characterizes these demographics, and informs targeted interventions to increase vaccination uptake and ensure equitable prevention strategies.

Opt-out vaccination in school and daycare: Reconciling parental authority and obligations.

An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents' decision-making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively 'opt out'. We suggest that such programmes reconcile parents' decisional authority and vaccination duties. First, opt-out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one's child that most parents have.

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

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

Electronic nudge letters to increase influenza vaccination uptake in younger and middle-aged individuals with diabetes: a prespecified analysis of the NUDGE-FLU-CHRONIC trial

Abstract Background Despite evidence demonstrating that influenza vaccination is associated with reduced risk of adverse cardiovascular events and all-cause mortality, influenza vaccine uptake remains suboptimal in persons with diabetes mellitus (DM). Purpose In this prespecified analysis of the NUDGE-FLU-CHRONIC trial we assessed the effectiveness of electronically delivered nudges on influenza vaccine uptake according to DM status. Methods NUDGE-FLU-CHRONIC was a nationwide, randomized, pragmatic implementation trial among younger and middle-aged (18-64 years) Danish citizens with chronic disease during the 2023/2024 influenza season. All trial participants were eligible for a free influenza vaccination through the Danish governmental vaccine program. Participants were randomized in a 2.45:1:1:1:1:1:1 ratio to usual care (no electronic letter) or one of 6 different electronic nudge letters delivered on Sep 26, 2023. Baseline and outcome data were obtained using the Danish nationwide registries. The endpoint was receipt of a seasonal influenza vaccine on or before Jan 1, 2024. Results Of 299,881 NUDGE-FLU-CHRONIC participants, 57,666 (19.2%) had DM at baseline. Participants with DM had a median age of 51.6 years, 43.0% were female, median Hba1c of 53 mmol/mol, median DM duration of 10.0 years, and 51.2% were insulin dependent. During follow-up, 43.0% of those with DM vs. 34.6% of those without DM received the seasonal influenza vaccine (p<0.001). Any electronic letter vs. usual care was highly effective in increasing vaccine uptake in participants with DM at baseline (45.6% vs. 36.5%, difference: +9.1 percentage points [99.29%CI: 7.9-10.3], relative risk ratio [RR]: 1.42, 99.29%CI: [1.39-1.44]). However, DM status modified the effect of any electronic letter such that participants without DM at baseline experienced a slightly greater effect than those with DM (37.3% vs. 25.9%, difference: +12.3 percentage points [11.7-12.8], RR: 1.47 [1.45-1.50]; p-interaction <0.001). For each individual electronic nudge letter, the effect of the intervention was slightly lower in participants with DM compared to those without (Figure 1; all p-interaction < 0.015). When assessing DM subgroups, the effect of any electronic letter vs. usual care was greater in participants with DM and concomitant cardiovascular disease than in those without, greater in non-insulin treated than in insulin-treated individuals, and greater in those with shorter diabetes duration. Effectiveness of nudges were consistent across all other DM subgroups including HbA1c level (Figure 2). Conclusions Electronic nudge letters significantly boosted vaccine uptake in a broad range of individuals with DM, but the effect was slightly lower compared to those without DM. Future studies should test whether behaviorally designed nudges may positively influence other health behaviors in people with diabetes.

Vaccination campaign implementation in Madagascar: a Dynamic Sustainability Framework approach

Abstract Background The COVID-19 pandemic has highlighted the need for equitable and timely access to vaccination. Limited evidence is available on how to implement vaccination campaigns (VCs) that are sustainable and responsive to changes in real-world health policy and practice contexts. We present lessons learned from the implementation of a COVID-19 VC in the Boeny region of Madagascar. Methods Informed by the Dynamic Sustainability Framework, VC implementation was continuously reviewed during multisectoral stakeholder feedback rounds, key informant interviews, and problem-solving meetings to identify and put key adaptations throughout the campaign process into practice. Outcome indicators include pre- and post-VC vaccine hesitancy and trends in vaccine doses deployed were analyzed using generalized linear models. Results Key adaptations of the implementation strategy included community-led awareness-raising and outreach activities also in remote areas, strengthening VC through the training of 340 staff, and addressing gaps identified in the cold chain, waste management, vaccine transportation, and IT equipment. Overall, 24888 COVID-19 vaccines were administered in six months. Changes in campaign strategy increased the number of doses administered by 8% (RR = 1.08; CI 95%: 1.01; 1.15) per week. No changes in vaccine hesitancy post-VC were observed in an unvaccinated population(Δ = 0.02, CI 95%: -0.04; 0.08). Conclusions Collaborative and dynamic multi-sectoral VC strategies that combine healthcare-based approaches with pro-active outreach and community-led awareness-raising activities are essential in increasing vaccine uptake in limited-resource settings. Our findings show that despite boosting vaccination coverage, such initiatives may not have an impact on COVID-19 vaccine hesitancy at the community level Key messages • Multisectoral stakeholder collaboration and engagement are key to successful vaccination campaign implementation. • A Dynamic Sustainability Framework approach can be effective in ensuring a continuous fit between campaign and its setting.

Organizational barrier to herpes zoster vaccination uptake in Europe: a systematic review

Abstract Background The Herpes Zoster virus represents a significant public health threat for unvaccinated frail individuals and older adults, aged 50 or older. Globally, 95% of elderly and frail individuals are susceptible to develop Herpes Zoster as already being exposed to Varicella Zoster Virus. Organizational and logistical barriers, such as cost management, vaccine storage requirements, supply limitation, logistic difficulties, absence of a streamlined collection system, and healthcare system deficiencies might reduce vaccination uptake. Methods A systematic review was conducted to identify studies published in the last 10 years, and focused on logistic and organizational barriers for Herpes Zoster vaccination uptake among frail and participants aged 50+ in Europe. Prisma guidelines were followed, and AXIS tool was used to evaluate the risk of bias. Results After a thorough analysis, 4 studies were selected from a total of 863 for detailed review. The analysis revealed several barriers to vaccination uptake, including challenges involving healthcare professionals, participant-related obstacles concerning perceptions and knowledge, accessibility issues, structural deficiencies, and social dynamics. A significant barrier identified is the perception among participants that general practitioners either do not support the vaccination or that participants themselves underestimate the risk of developing Herpes Zoster. Additionally, current communication strategies have proven inadequate, indicating a need for more effective and updated approaches to increase public awareness. These factors contribute to hesitancy regarding vaccination. Conclusions This study provides a comprehensive examination of the organizational and logistical barriers to the Herpes Zoster vaccination uptake. Tailored interventions are essential to overcome these barriers. Successfully addressing these challenges might enhance vaccination rate and reduce the public health burden associated with Herpes Zoster. Key messages • Several logistic and organizational barriers reduce the Herpes Zoster vaccination uptake. • Further literature is required to understand how to overcome those barriers, and increase vaccination uptake.

HPV vaccination in Croatia (2016-2023): Increased vaccine uptake and declining sex disparities

Abstract Background The Human papillomavirus (HPV) is a known cause of cervical cancer, and is associated with the development of vaginal, vulvar, anal, penile, and head and neck cancer. The availability of the HPV vaccine has enabled generations of young people to be protected from HPV-related cancers. In 2016, a national immunization program targeting 14-year-old girls and boys has been initiated in Croatia. To date, systematic data on HPV vaccination coverage (VC) in Croatia is lacking. This study aims to determine HPV VC, examine trends in HPV vaccination in Croatia from 2016 to 2023 in the context of the national vaccination program, and assess differences between sexes. Methods The study is designed as a retrospective analysis covering the data from 2016 to 2023, collected from primary healthcare providers. HPV VC within 2000-2008 birth cohorts (BC) are analyzed for all vaccinated with at least one dose and assessed by sex. The trend in HPV vaccination is shown using joinpoint regression. The chi-square for trend is used to compare the vaccination coverage of females (FVC) and males (MVC). The rate ratio between FVC and MVC is calculated. Results HPV VR increased significantly among observed BCs from 6,44 % in 2000 BC to 44,22 % in 2008 BC (FVC rose from 10,67 % to 52,78 %, and males MVC from 2,47 % to 36,05 %). Joinpoint analysis revealed a statistically significant increase in all birth cohorts, while the steeper increase is seen in 2000-2006 BCs (APC = 35,47, P < 0,05) than in 2006-2008 BCs (APC = 13,93, P < 0,05). FVC is significantly higher than MVC in all birth cohorts (Extended Mantel-Haenszel chi-square for linear trend = 809.23, P < 0,001). The highest FVC/MVC rate ratio was observed in the initial 2000 BC (4,31), and the lowest in the last 2008 BC (1,46). Conclusions In Croatia, HPV VC continuously increases among observed BCs. The positive trend is present in both sexes, and the rate ratio between female and male cohorts is decreasing. Key messages • The study presents a systematical overview of HPV vaccination coverage in Croatia from the beginning of the national immunization program, which is crucial for monitoring progress. • In the following years, if the revealed trends persist or advance, Croatia could be closer to reaching Europe’s Beating Cancer Plan concerning eliminating HPV-related diseases.

Measuring Vaccine Literacy in Switzerland: How is the situation after COVID-19?

Abstract Background Vaccinations are one of the most effective medical health interventions and one of the most important preventive measures. However, the population is often unsure about vaccination, and the roles and responsibilities of the key actors seem often unclear. To adequately protect the population against vaccine-preventable diseases, the Swiss Confederation, the Cantons and other stakeholders have developed the National Vaccination Strategy and an associated action plan. For its implementation, studies on the population’s knowledge, attitudes, skills, and vaccination behavior are crucial. Thus, the Swiss Federal Office of Public Health launched a study to assess vaccine literacy and its relation to vaccination readiness and behavior in the adult population in Switzerland. Methods A representative sample of 2,500 people living in Switzerland will be surveyed in summer 2024. The online questionnaire will include validated instruments, e.g. the HLS19-VAC Instrument to measure vaccine literacy or the 7C Vaccination Readiness Scale, as well as questions on correlates of vaccine literacy, vaccination readiness and behavior. Results The results of the survey will be presented, with a focus on vaccine literacy, vaccination readiness and behavior and their correlates. Specifically, differences among the three main language regions and between specific population groups will be shown. Further, a comparison with data from previous studies will be presented. Conclusions Despite having an advanced healthcare system, to date Switzerland has only partially reached its objectives in terms of vaccination, both for individual protection and collective immunity. New data on vaccine literacy, vaccination readiness and behavior as well as on the influencing factors are needed, especially after the pandemic, to guide effective future actions and measures to improve the vaccine coverage and public health in Switzerland. Key messages • Due to the COVID-19 pandemic the topic of vaccination in general has received increasing attention and may has changed people’s knowledge and attitudes towards vaccination. • Newest data on vaccine literacy, vaccination readiness and behavior are necessary to inform future, targeted actions and increase vaccine uptake.

10.O. Scientific session: Breaking Barriers: Advancing Vaccine Access for Newly Arrived Migrants in Europe

Abstract Health disparities are particularly evident in Europe among Newly Arrived Migrants (NAM), in accessing healthcare systems and navigating vaccination services. The AcToVax4NAM project emerged as a pioneering initiative aimed at identifying solutions to overcome system barriers, following a life-course approach. These solutions consist of a broader strategy to promote organisational vaccination literacy and enhance vaccine uptake among NAM. Employing a participatory approach, the project engaged with professionals FOR health (PFH) and ΝΑΜ to ensure the relevancy of the practices developed, along with the widespread acceptance of proposed solutions and tools tackling access to vaccination services. This workshop is not just about showcasing the outcomes and impact of the AcToVax4NAM project; it’s about equipping PFH with practical tools and strategies that are immediately applicable and will ultimately increase vaccine literacy and uptake. By delving into the challenges encountered, strategies employed, and recommendations formulated, the workshop offers invaluable insights for professionals seeking to address similar issues in their respective contexts. We believe that by sharing our experiences and best practices, we can empower others to make a real difference in their communities. The workshop will contain 5 presentations that follow the functional structure of the project, starting with a presentation on the General Conceptual Framework, the foundational element guiding project activities. Following this, we will discuss the development of a migrant-centered and migrant-sensitive tool aimed at improving the communication skills of PFH by providing definitions of vaccine-related terms in an easily digestible way. The third presentation will detail the development of action-oriented flowcharts across consortium countries validated through focus group discussions with PFH; the flowcharts are linked to a comprehensive repository of 359 tools. The workshop will then explore the consortium’s efforts in providing vaccine literacy and cultural competency training to more than 200 healthcare professionals. Finally, the outcomes of the pilots implemented in consortium countries will be presented, and recommendations will be made that summarize the evidence-based accumulation of improved access to vaccinations for NAM and, consequently, increase vaccine uptake. This workshop fosters dialogue among stakeholders and showcases collaborative efforts to promote vaccination literacy and uptake among NAMs in Europe. Sharing experiences and best practices empowers PFH to address similar challenges in their communities, offering insights into effective strategies for improving healthcare access and promoting health equity. Finally, insights from the presentations and discussions can inform evidence-based policymaking and shape the development of immunization public health strategies at the local, national, and European levels, inspiring real change in communities. Key messages • Equipping Professionals for Health with strategies to Enhance Vaccine Access for Newly Arrived Migrants. • Equity through Collaborative Efforts in Promoting Vaccination among Newly Arrived Migrants.

An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project

Abstract Issue/problem Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients. Description of the problem The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally. Results Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%). Lessons The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions. Key messages • Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients. • Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.

Leveraging Social Marketing to Increase Vaccination Rates: A Systematic Review

Abstract Introduction Vaccinations are crucial for protecting individuals from preventable diseases, serving as a cornerstone of public health, safeguarding entire populations. Low vaccination rates can have devastating consequences, leading to outbreaks of preventable diseases. Social marketing has had an increasing role to play in public health. This systematic review seeks to investigate social marketing effectiveness in boosting vaccination adherence. Methods A literature search was conducted in PubMed, Scopus and Cochrane Library, using keywords “social marketing”, ‘campaigns”, “vaccination”, “vaccination uptake”. The search was limited to English-language studies, including studies discussing social marketing campaigns and its impact on vaccination uptake. Prior to inclusion, the studies were evaluated for relevance and applicability to the research question. Included studies were analysed for methodology, sample size, data collection methods, and key findings. Results Of 198 articles identified, 26 studies met inclusion criteria. All studies reported demonstrable improvement in vaccination adherence and hence higher vaccination rates with the use of social marketing campaigns. Targeted messaging on social media allows communication to be tailored to specific demographics and address their unique concerns. Community engagement combats vaccine hesitancy by dismantling misinformation and rebuilding trust. Additionally, these campaigns leverage social influence and mobilise communities to cultivate pro-vaccine attitudes. By addressing personal choice, knowledge gaps, and hesitancy, social marketing paves the way for greater vaccination uptake. Conclusions Social marketing has been proven to be an effective tool in promoting vaccination adherence in public health. As vaccination remains a critical aspect of public health, the continued use of social marketing interventions is essential for improving vaccination rates and ultimately enhancing overall population health. Key messages • Social marketing campaigns lead to higher vaccination rates across various populations. • By addressing vaccine hesitancy, social marketing paves the way for increased vaccination uptake.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

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.

COVID-19 vaccine implementation at a syringe services program: experiences of frontline staff

BackgroundWhile people with substance use disorders, including people who inject drugs (PWID), experience increased risk for COVID-19 infection and adverse outcomes, COVID-19 vaccination rates among PWID are consistently lower than those observed in the general population. Offering COVID-19 vaccines at syringe services programs (SSPs) has been proposed as a critical strategy to increase vaccine uptake among this population. We explored the experiences of frontline staff at an SSP in Miami, Florida implementing onsite COVID-19 vaccines.MethodsBetween June and July 2022, we conducted in-depth semi-structured interviews with 17 staff members of an SSP in Miami, Florida. Data collection and codebook thematic analysis of transcribed interviews were guided by the Consolidated Framework for Implementation Research (CFIR).ResultsFacilitators and barriers of COVID-19 vaccine implementation at the SSP aligned with all major CFIR domains. Key facilitators included the SSP’s established partnership with the local health department for vaccine distribution, its existing funding sources which could be leveraged for vaccine-related expenses, consensus among staff about the need for new strategies to increase vaccine uptake among PWID, and PWID’s trust in the SSP. Major—but largely modifiable—barriers included lack of participant compensation, limited internal collaboration and communication regarding the vaccine initiative beyond implementation leads and innovation deliverers due to competing priorities and segmented roles and responsibilities, and insufficient involvement of the most participant-facing staff (i.e., the SSP’s peer navigators and outreach workers).ConclusionsImplementing onsite COVID-19 vaccines was perceived as feasible and acceptable by frontline staff at the SSP, however contextual factors impeded optimal implementation. Multilevel strategies, such as participant compensation for vaccine completion and internal educational meetings with staff to improve vaccine implementation and reach, are required. As a trusted source of preventative services for PWID, SSPs are an underutilized venue for increasing vaccine uptake among this population, and findings from this study could inform the expansion of low-barrier vaccine services at SSPs nationwide.

COVID-19 vaccination intention among people who use drugs in France in 2021: results from the international community-based research program EPIC

BackgroundCOVID-19 vaccination is crucial to reduce the incidence of severe forms of the disease in the population. However, people who use drugs (PWUD) face structural and individual barriers to vaccination, and little is known about vaccination intention and factors associated with that intention among PWUD. This study aimed to estimate vaccination intention in PWUD and associated factors in the early stage of vaccination campaigns.MethodsWe conducted cross-sectional study in France among PWUD, as part of the international EPIC program, a community-based research study coordinated by Coalition PLUS. It included 166 unvaccinated PWUD attending harm reduction centers. A questionnaire collected data on sociodemographic characteristics, COVID-19 related difficulties, and mental health, among other things. Multivariate logistic regression was used to identify factors associated with low vaccination intention.ResultsOnly 19% of participants reported strong intention to get vaccinated against COVID-19. Factors independently associated with low vaccination intention were younger age (aOR = 0.90, 95%CI = 0.85–0.95), lower education level (aOR = 2.67, 95% CI = 0.95–7.55), and unstable housing (aOR = 6.44, 95% CI = 1.59–40.34). The most-cited reasons for low intention were mistrust in COVID-19 vaccines (66.1%), fear of side effects (48.7%), and non-belief in vaccinations in general (25.2%).ConclusionsThis study highlights the need for targeted COVID-19 information and interventions to increase vaccine uptake in PWUD, especially those living in precarity. Community-based interventions and targeted government assistance could play a crucial role in addressing vaccine hesitancy in this population, not only for COVID-19 but for future epidemics.

Factors associated with COVID-19 vaccine hesitancy and uptake among populations in the West department of Haiti.

The COVID-19 pandemic in Haiti led to increased challenges for a population concurrently dealing with natural and social disasters, poor quality health care, lack of clean running water, and inadequate housing. In 2022, the population of Haiti was 11.4 million. While half a million vaccines for COVID-19 were donated by the United States to the government of Haiti, less than 5% of the population agreed to be vaccinated. This resulted in thousands of unused doses that were diverted to other countries. The purpose of this study was to evaluate population characteristics related to vaccine uptake in order to inform future interventions to improve COVID-19 vaccine uptake as well as inform strategies to safeguard against future global health security threats. This was a mixed-methods, cross-sectional study conducted in the West Department of Haiti within peri-urban communes. Participants consisted of adults in this setting responding to a survey from June 15 to July 18, 2022. The survey assessed demographic information, household characteristics, religious beliefs, past vaccine use, and current COVID-19 vaccine status. Multivariate regression modeling was conducted to assess predictors of vaccine hesitancy. Qualitative focus group discussion participants were recruited and focus group discussions were conducted between August-September 2022 among community groups, religious leaders and health professionals to provide additional, community-level context on perceptions of the COVID-19 pandemic and vaccines. A total of 1,923 respondents completed the survey; of which a majority were male (52.7%), between the age of 18-35 (58.5%), had a medical visit within the last year (63.0%) and received the COVID-19 vaccine (46.1%). Compared to those who had been COVID-19 vaccinated, participants who had not been vaccinated were more likely to be male (57.7% vs 46.8%, p < .0001), have completed secondary education (30.5% vs 16.6%, p < .001), unemployed (20.3% vs 7.3%, p < .0001) and had a medical visit 3 or more years ago (30.2% vs 11.2%, p < .0001). Unvaccinated COVID-19 participants were also more likely to have never received any other vaccine (36.1% vs22.5%, p < .0001), have a religious leader speak out against the vaccine (20.0% vs 13.1%, p < .0001), not believe in the effectiveness of the vaccine (51.2% vs 9.1%, p < .0001) and did not trust the healthcare worker administering the vaccine (35.2% vs 3.8%, p<0.0001). These results show that targeted interventions to religious leaders and health care workers on how to engage with the community and share clearer messages around the COVID-19 vaccination may result in increased vaccine uptake. Results also shed light on how activities surrounding vaccinations can be tailored to meet client needs addressing the misinformation encountered to achieve greater health impact thereby safeguarding the population against future global health security threats.

Connecting the experiences of persons with disabilities and social workers in Nigerian care institutions regarding COVID-19 vaccine uptake: a qualitative descriptive-interpretive design.

During the COVID-19 pandemic, persons with disabilities (PWDs) have faced additional disadvantages that have exacerbated their physical and mental health challenges. In Nigeria, where cultural, religious, and informational barriers persist, understanding these factors is critical for improving health interventions, including vaccine uptake among PWDs. This study employed a qualitative descriptive-interpretive design to explore the perceptions of PWDs regarding the COVID-19 pandemic and the vaccine, alongside social workers' views on their roles in facilitating vaccine uptake. We conducted in-depth semi-structured telephone interviews with 20 participants, comprising 16 PWDs and four social workers in Nigerian rehabilitation homes. Data were analyzed using critical thematic analysis to identify key themes influencing attitudes toward the pandemic and vaccine uptake. The study uncovered significant barriers to COVID-19 vaccine uptake among PWDs, primarily driven by mistrust in government initiatives, widespread conspiracy theories, and deeply held cultural and religious beliefs. Additionally, while social workers played crucial roles as community surveillance officers, in-house educators, and community referral agents, their interventions lacked specific strategies aimed at increasing vaccine uptake among PWDs. Their efforts were more focused on addressing the psychological impacts of the pandemic rather than fostering behavioral changes toward vaccine acceptance. To enhance COVID-19 vaccine uptake among PWDs in Nigerian rehabilitation homes, targeted interventions that address the identified barriers are essential. These should include trust-building measures, culturally and religiously sensitive communication strategies, and tailored educational programs by social workers. Moreover, training social workers in specific, evidence-based strategies to increase vaccine uptake is crucial for mitigating the pandemic's impact on this vulnerable population.