Understanding Vaccine Hesitancy Research Articles

“There's a lot of factors”: Researcher reflections on using I-Poetry to empathetically understand vaccine hesitant individuals

Background: Despite higher vaccination rates compared to other age groups, many US older adults remain under-vaccinated against preventable diseases leading to increased risk of serious illness, hospitalization, or death posed from disease. This study investigates the underlying reasons for older adults not getting vaccinated. Methods: From a larger interview study conducted in North Dakota, eight older adults (Mean Age = 73) were identified as being vaccine hesitant. Participants were asked, “How do you decide about whether or not to get a specific vaccine?” Then, participants' responses were analyzed using the I-poetry qualitative methodology, which involves creating a poem from interview transcripts to capture the essence of participants' experiences. Results: Poetic findings clarify interacting sources of immunization unease and highlight potential intervention avenues for medical professionals. Specifically, the poetic analysis revealed themes of mistrust in the healthcare system, preference for natural immunity, and concerns about vaccine side effects. The study suggests that healthcare professionals should consider using empathetic communication strategies to address vaccine hesitancy in older adults. Conclusions: Understanding vaccine hesitancy as a tapestry instead of individual factors may be more useful for older adults who culminate their hesitant beliefs from prior life experiences. Additionally, to improve trust in healthcare providers, it is suggested that more first-person narratives of older adult experiences are used and solicited by healthcare providers. Possible interventions are discussed.

Understanding Vaccine Hesitancy: A Comparison of Sociodemographic and Socioeconomic Predictors with Health Literacy Dimensions.

Vaccine hesitancy represents a global public health challenge that can diminish the effectiveness of vaccination programs. Research indicates that various sociodemographic and socioeconomic factors, along with health literacy, predict vaccine hesitancy. In this study, we analyzed data from a Slovenian health literacy survey that included 3360 adult participants. We examined the effects of sociodemographic (gender and age) and socioeconomic factors (education, economic deprivation, and self-assessed socioeconomic status), as well as different dimensions of health literacy (general, communicative, and navigational), on vaccine hesitancy. The results show that age, education, and economic deprivation are statistically significant predictors of vaccine hesitancy; younger individuals, those with lower education levels, and those experiencing greater economic deprivation express increased vaccine hesitancy. Higher levels of general and communicative health literacy are associated with lower vaccine hesitancy, while navigational health literacy was not found to be a statistically significant predictor of vaccine hesitancy.

A multidimensional approach to understanding vaccine hesitancy among first generation college students

Objective: Vaccine hesitancy has increased over the past several years limiting effectiveness. The primary objective of this study was to investigate which dimensions of vaccine hesitancy are most prominent among first generation college students (FGCS), an underexplored group. Secondly, this study explored sociodemographic differences in vaccine hesitancy within this population. Given that FGCS often function as health information gatekeepers for their family, increasing our understanding of these relationships may have far-reaching effects beyond the college setting. Materials and Methods: A sample of n = 339 undergraduate FGCS completed an online survey. Vaccine hesitancy was measured using the Multidimensional Vaccine Hesitancy Scale (MVHS) and sociodemographic variables were collected. Results: Cost, fear of physical pain, and long-term health risks associated with vaccination emerged as the leading factors of vaccine hesitancy for FGCS. Unexpectedly, low frequency social media FGCS reported significantly higher vaccine hesitancy scores compared to high users. Conclusions: Increasing our understanding of vaccine hesitancy will aid public health professionals in developing more efficacious vaccine interventions for this population.

Understanding Vaccine Hesitancy in U.S. Prisons: Perspectives from a Statewide Survey of Incarcerated People.

Much of the American response to the COVID-19 pandemic was characterized by a divergence between general public opinion and public health policy. With little attention paid to individuals incarcerated during this time, there is limited direct evidence regarding how incarcerated people perceived efforts to mediate the harms of COVID-19. Prisons operate as a microcosm of society in many ways but they also face unique public health challenges. This study examines vaccine hesitancy-and acceptance-among a sample of individuals incarcerated within adult prisons in Pennsylvania. Using administrative records as well as rich attitudinal data from a survey of the incarcerated population, this study identifies a variety of social and historical factors that are-and are not-associated with an incarcerated person's willingness to receive the COVID-19 vaccine. Our findings highlight vaccination challenges unique to the carceral context and offer policy recommendations to improve trust in credible health messengers and health service provision for this often overlooked but vulnerable population.

Hesitant or Confident: A Qualitative Study Examining Latinos' Perceptions of COVID-19 Vaccines in Arizona.

This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.

Understanding vaccine hesitancy: a call for more social science in RNA vaccine research

Understanding vaccine hesitancy: a call for more social science in RNA vaccine research

Psychological reactance, misinformation, and distrust: A mixed methods analysis of COVID-19 vaccine uptake.

Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities. This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47). The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom. Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.

COVID-19 Vaccine Hesitancy among Unvaccinated Adults: A Cross-Sectional Exploratory Analysis of Vaccination Intentions in Italy Related to Fear of Infection.

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36-1.62); it was highest in the 50-59 and 40-49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46-0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46-4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics.

COVID-19 Vaccine Mandates and Vaccine Hesitancy among Black People in Canada.

COVID-19 vaccine mandates increased vaccination rates globally. Implemented as a one-size-fits-all policy, these mandates have unintended harmful consequences for many, including Black Canadians. This article reports findings on the interconnectedness of vaccine mandates and vaccine hesitancy by describing a range of responses to mandatory COVID-19 vaccination policies among Black people in Canada. Using qualitative research methods, semi-structured interviews with 36 Black people living in Canada aged 18 years and over across 6 provinces in Canada were conducted. Participants were selected across intersectional categories including migration status, income, religion, education, sex, and Black ethnicity. Thematic analysis informed the identification of key themes using Foucauldian notions of biopower and governmentality. Our results show how the power relations present in the ways many Black people actualize vaccine intentions. Two main themes were identified: acceptance of the COVID-19 vaccine in the context of governmentality and resistance to vaccine mandates driven by oppression, mistrust, and religion. COVID-19 vaccine mandates may have reinforced mistrust of the government and decreased confidence in the COVID-19 vaccine. Policy makers need to consider non-discriminatory public health policies and monitor how these policies are implemented over time and across multiple sectors to better understand vaccine hesitancy.

Understanding vaccine hesitancy in US and UK frontline workers – The role of economic risk

Drawing upon a comparative qualitative study of frontline workers in the US and UK this research confirms Bazzoli and Probsts’ (2022) emphasis on employment instability as a limiting boundary condition for effective implementation of a strong safety climate. It suggests that there is no positive relationship between risk of Covid-19 infection and frontline worker attitudes toward the vaccine because of their exposure throughout the pandemic. The notion of moral disengagement is problematic because of the tension between the vaccine hesitancy of frontline workers and the pro-social roles they fulfilled in the pandemic. Their exposure, underpinned by dependence on non-standard contracts and limited access to sick pay, informed vaccine hesitancy. Trust in management, but also perceptions of economic risk and safety in the work environment, shape vaccine behaviour and point to the importance of workplace health and safety policies. The research suggests the necessity of work-related variables in exploring vaccine hesitancy, but also consideration of the wider political economy of legal, health and welfare systems in both countries, including hostile migration environments. While vaccination was more politicised in the US, the intersection of race and class were key factors in both countries because of the predominance of BME and BIPOC workers in essential work during the pandemic and disproportionate exposure to the virus.

COVID-19 vaccine hesitancy among healthcare workers and its associated factors: A systematic review

Abstract Background The COVID-19 pandemic is considered one of the most significant public health crises in the 21st century. Healthcare workers (HCWs) as frontliners are at a greater risk of infection compared to the general population. HCWs can influence the general public's decisions when it comes to their health, particularly vaccination. Vaccine hesitancy can be a threat to controlling pandemics, at times when timely interventions are needed to save lives and reduce the burden on healthcare systems. Understanding vaccine hesitancy among HCWs can inform policy change and better pandemic preparedness. Methods This systematic review investigated vaccine hesitancy and its associated factors among HCWs following the approval of the first COVID-19 vaccine. Searches were run in three databases on eligible studies published between December 2, 2020, and June 15, 2022. Results We included 24 studies with a total of 74,739 [241- 12,610] HCWs from 12 countries including the United States, China, Germany, Belgium, Switzerland, and Greece. Most studies were conducted shortly after vaccine approval. The average prevalence of vaccine hesitancy across the studies was 24%. Factors associated with vaccine hesitancy among HCWs were classified using a five categories ‘5C model': confidence, complacency, convenience, communication, and context. Age, gender, healthcare profession, a history of flu vaccination, a positive history of COVID-19 infection, and confidence in COVID-19 vaccine safety were the most commonly identified factors associated with vaccine hesitancy. Conclusions This review suggests that the reasons underlying vaccine hesitancy among HCWs are multifactorial and might be unrelated to vaccine availability. Future studies could study vaccine hesitancy on a wider timeline following vaccines approval, to understand whether low uptake reflects hesitancy or a delay in vaccination. Understanding vaccine hesitancy among HCWs is crucial for pandemic preparedness and control. Key messages • Understanding vaccine hesitancy among healthcare workers and its underlying factors is crucial for pandemic preparedness and response. • Vaccine hesitancy among healthcare workers is multifactorial and may be unrelated to the availability of vaccines. Future research should expand on this topic to understand factors underlying it.

“Messengers matter”: Assessing the impact of racially concordant care on vaccine hesitation

With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.

Perspectives and experiences of COVID-19 vaccination in people with autoimmune and inflammatory rheumatic disease

ObjectivePeople with autoimmune and inflammatory rheumatic disease (AIIRD) are at an increased risk of morbidity from COVID-19. While COVID-19 vaccination is effective at reducing disease complications, there have been significant levels of vaccine hesitancy in people with AIIRD. We aimed to understand vaccine hesitancy and promote shared decision-making by describing the experiences and perspectives of people with AIIRD who had concerns with COVID-19 vaccinations. MethodsAdults with AIIRD on immunosuppressive medications who expressed concerns regarding the COVID-19 vaccination were purposively sampled until thematic saturation. Individual semi-structured interviews were conducted and analysed using reflexive thematic analysis. ResultsSixteen adults with an AIIRD were interviewed. Thematic analysis yielded four themes: heightened sense of vulnerability; determining individual suitability; desperate for freedom and relief; deterred by scepticism. ConclusionsThe perspectives of people with AIIRD towards the COVID-19 vaccination were shaped by a sense of vulnerability. The decision-making experience was challenging, resulting from struggles with handling information, dealing with external pressures, and facing negativity. Practice ImplicationsA collaborative approach, involving close family and friends and avoiding negativity and pressure can improve engagement and support decision-making around COVID-19 vaccination. Clearly addressing potential risks of vaccination may prevent subsequent regret and hesitancy if they arise.

Vaccine Hesitancy and Attitudes Toward Elite Knowledge in the United States During COVID-19

To be effective, the battle against COVID-19 and other pandemics must address the social dimensions of the crisis. The objective of this study was to assess whether negative attitudes toward elite knowledge were associated with vaccine hesitancy in the United States during COVID-19. Attitudes toward elite knowledge were assessed using three measures: (a) the Epistemological Style Inventory’s ‘naive realism’ subscale, (b) a measure about supporting education to foster understanding of politics, and (c) a populism scale. Vaccine hesitancy was measured using a 9-item adaptation of the Vaccine Hesitancy Scale used by the World Health Organization. Multiple regression results revealed that naïve realism (.184, p < .001) and populism (.356, p < .001) were positively associated with vaccine hesitancy, while support of political education (−.296, p < .001) was negatively associated with vaccine hesitancy. These results indicate that to fully understand vaccine hesitancy, the role of attitudes toward elite knowledge must be considered.

Unvaccinated, Just Like Everybody Else. Vaccine Hesitancy in a Romanian Religious Community

Abstract Vaccine hesitancy was a widespread phenomenon during the COVID-19 pandemic. It held back large-scale immunization in countries where vaccines were available and it aggravated the pandemic. The way we understand vaccine hesitancy in postmodern societies emphasizes individual risks, reflexivity, and patients making informed decisions. But how is vaccine hesitancy experienced in traditional communities? We explored answers to this question through ethnographic interviews conducted in the least vaccinated village in Romania. In this Pentecostal community, vaccination decisions were made at the community level, where an informal norm of vaccine refusal was dominant. This norm emerged through two types of interactions – local and mediated interactions – as collective discussions were centred on religious interpretations of Biblical fragments and on information from TV shows and social media about the adverse effects of vaccines. People formed symbolic alliances with influential actors in their community who were unvaccinated, such as the mayor and the pastor, and with citizens from Western European countries who also refused COVID-19 vaccination. Mainstream fears of vaccination were expressed during the interviews, concerning paralysis and death resulting from vaccination and mistrust in official authorities. Vaccination accentuated pre-existing differences in status, demarcating people with a high level of education working at the village hall, who were vaccinated, from those with a lower socio-economic status, who were not vaccinated.

Understanding vaccine hesitancy with PCV13 in children: Results of a survey in Shanghai, China.

A questionnaire survey for parents of children under 5 years of age was conducted to analyze vaccine hesitancy with the 13-valent pneumococcal conjugate vaccine (PCV13) in Shanghai, China. A total of 892 valid questionnaires were collected. Descriptive statistical methods, Chi-square test and effect size of Cohen were used. Among participants, 421 (48.8%) had children who had been vaccinated with PCV13 before the survey while 227 (26.73%) planned vaccination with PCV13 in the future. The main reasons for not receiving vaccination were the fear of adverse reactions (79, 26.7%), beyond vaccination age (69, 23.3%), and no need to vaccinate (44, 14.9%). Reducing vaccine hesitancy and increasing vaccination willingness can be achieved through health interventions, lower vaccine prices, and the adjustment of vaccination strategies.

Knowledge Gaps, Cognition and Media Learning: Designing Tailored Messages to Address COVID-19 Communication Inequalities

Various health and crisis studies have demonstrated support for the existence of knowledge gaps—a hypothesis suggesting that information will reach those in the lower socioeconomic status last, worsening health disparities. At the point at which COVID-19 vaccines were becoming widely accessible, the present study surveyed 651 Black Americans to understand vaccine hesitancy, intentions, and media learning variations after exposure to different types of social media posts about the COVID-19 vaccine. Although exposure to any of the message conditions in our study resulted in a decrease in vaccine hesitancy, we found mixed support for the knowledge gap hypothesis. Results show that lack of knowledge because of socioeconomic status is not a key factor driving vaccine hesitancy among Black Americans. Instead, public communication (government) campaigns may consider focusing on strategies to target Black American communities by age to improve media learning, and consider increasing social control and communal message functions to increase cognitive processing of pro-vaccine messages, and over the longer term, influence COVID-19 vaccine hesitancy and uptake.

International Medical Corps’ Approach to Solving COVID-19 Vaccine Hesitancy

To promote equity and better ensure outbreak control in low-resource areas, International Medical Corps surveyed people in countries around the world to better understand vaccine hesitancy.

Broad perspectives in understanding vaccine hesitancy and vaccine confidence: an introduction to the special issue.

The World Health Organization has designated vaccine hesitancy and vaccine confidence among the most pressing issues in global health. The COVID-19 pandemic has made vaccine hesitancy and vaccine confidence particularly salient and urgent. The purpose of this special issue is to highlight a broad range of perspectives on these critical issues. We have included a total of 30 papers that address issues related to vaccine hesitancy and vaccine confidence across multiple levels of the Socio-Ecological Model. We have organized the empirical papers into the following sections: individual-level beliefs, minority health and health disparities, social media and conspiracy beliefs, and interventions. In addition to the empirical papers, three commentaries are included in this special issue.

Health Misinformation on Social Media and its Impact on COVID-19 Vaccine Inoculation in Jordan

It is vital to understand the nature of misinformation disseminated online regarding the COVID-19 vaccination. This understanding will enhance governments’ efforts and strategies to combat the factors which hinder vaccine uptake. Vaccine hesitancy has always been a challenge which has accompanied vaccine rollouts. Misinformation regarding the COVID-19 vaccination, along with the ambiguous narratives around the origin of the virus, has played a role in vaccine hesitancy among Jordanians. The online activity generated by social media during the pandemic, due to people’s fear of the virus, their general anxiety and curiosity, and their desire for updates, made social media an even more fertile environment for misinformation than ever before. During the COVID-19 pandemic in Jordan, misinformation on social media platforms amplified the scale of fears around the safety of the vaccination programme. Therefore, this study offers an exploration of, and insight into, the thoughts and experiences of a sample of 30 Jordanian citizens who are hesitant about COVID-19 vaccination. This study uses a qualitative approach in order to further understand vaccine hesitancy and the nature of misinformation surrounding it, using semi-structured, face-to-face interviews with participants. It found that low levels of information about health, misconceptions about the COVID-19 vaccine, and the spread of misinformation on social media were all causes of vaccine hesitancy in Jordan. Facebook and WhatsApp were the principal social media networks identified in this study as spreading misinformation about the vaccine. The study sample reported that they believed in the conspiracy theories discussed on these two platforms. Furthermore, videos of influencers and anti-vaccination medical doctors from overseas played a part in misleading individuals regarding inoculation against COVID-19. Additionally, other factors were also identified and are discussed in this study.