Vaccination Barriers Research Articles

Awareness, Coverage, and Barriers to COVID-19 Vaccination Among Undergraduate Students in Nigeria

BACKGROUND: With the resumption of physical learning activities across Nigeria's higher education institutions, tertiary-level students, a prioritized group according to the WHO SAGE in the deployment of the COVID-19 vaccines, face circumstances that necessitate widespread vaccination coverage among them. This is critical in view of vaccine hesitancy attitude and low vaccination coverage that has been reported among this subpopulation and the larger Nigerian populace. Surmounting these barriers is necessary to achieving a successful national vaccination program and for future pandemic preparedness and response. To this end, this study aimed to assess Nigerian undergraduate students' knowledge, coverage, and barriers to COVID-19 vaccination. METHODS: A cross-sectional survey of Nigerian undergraduates was conducted in October 2021, using an online questionnaire and a non-probability convenient sampling technique. The questionnaire included sections on respondents' demographic characteristics, COVID-19 vaccine awareness, coverage, barriers, and recommendations. A total of 326 respondents electronically completed and returned the informed consent form along with the questionnaire. Microsoft Excel spreadsheet and statistical package for the social sciences (SPSS) version 25 were used to code and analyze the data, respectively. RESULTS: The overall awareness of COVID-19 vaccines among the sampled students were high, with 62.3% having good knowledge, 20.9% having average knowledge, and 16.9% having poor knowledge. However, the majority of the respondents (81.3%) had not received the vaccines. The most prominent barrier to vaccination was misinformation about vaccine safety (23.6%). Opening vaccination centers on campuses (18.6%), demonstrating vaccine effectiveness and safety (18.7%), and organizing awareness campaigns (17.2%) were the most frequently recommended actions. CONCLUSION: Most respondents were aware of the availability and potential benefits of COVID-19 vaccines; however, coverage remained extremely low. Our findings emphasize the importance of addressing vaccination barriers by public health stakeholders to achieve optimal COVID-19 vaccine coverage.

Monkeypox (Mpox) Vaccine Hesitancy Among Mpox Cases: A Qualitative Study

Human mpox has been an increasing concern in the United States and California since late 2022. While the Jynneos vaccine offers a degree of cross-protection against the disease, vaccine hesitancy is common among those recommended for vaccination. The purpose of this study was to assess vaccine knowledge, facilitators, and barriers to vaccine uptake among individuals previously diagnosed with mpox, or mpox cases, in Santa Clara County, California. In-depth interviews were conducted by public health department staff among mpox cases diagnosed in Santa Clara County between July and September 2022. Responses were analyzed using a grounded theory data analysis approach. Among the 47 participants, 36 (77%) had heard of mpox before diagnosis, and of these, 20 (56%) did not think they were at risk of developing mpox, and 28 (78%) were aware that a vaccine was available. Those who did not receive the vaccine stated vaccine access and availability were the main barriers. Among the six participants not interested in the vaccine, the main hesitancies were lack of perceived risk, stigma of being branded by scarring and labeled gay, and vaccine safety. Overall, the following themes were attributed to reasons for vaccine hesitancy: (a) lack of awareness of the disease and vaccine, including perceived risks; (b) lack of vaccine availability and accessibility; and (c) stigma associated with receiving the vaccine, including being publicly labeled as “gay” and the scarring on forearm potentially seen as branding. We recommend tailoring outreach and educational campaigns to address reasons for mpox vaccine hesitancy.

Time lapses between distribution of influenza vaccines to health authorities and their administration by General Practitioners (GPs) to older adults: a retrospective study over five influenza seasons in Italy

ABSTRACTBackgroundDelays in influenza vaccine delivery and administration can hinder vaccine coverage and protection. This study examines the differentials in distributing and administering adjuvanted trivalent (aTIV) and quadrivalent influenza vaccines (aQIV) to older adults in Italy’s primary care setting and its potential impact on hospitalization risk over 5 epidemic seasons.MethodsUsing a primary care database, individuals aged ≥ 65 years were selected. The proportion of vaccine distribution to regional authorities and subsequent administration by GPs was estimated using census data. Using quantile (median) regression, we examined the relationship between velocities of vaccine distribution and administration (doses/week) and the incidence of hospitalizations.ResultsOver the 5 influenza seasons, the velocity of distribution and administration of aTIV/aQIV ranged 341–833 and 152–270 median doses/week; no trend was yielded for the difference between these velocities (p = 0.189) or vaccine coverage (p = 0.142). An association was observed for each differential dose/week between distributed and administered vaccines and all-cause hospitalizations with a 10% increase in 2017–2018, 54% in 2018–2019, and 12% in 2020–2021 season.ConclusionsThese findings highlight the importance of minimizing the time lapse between vaccine distribution and administration to mitigate the impact of influenza and address factors that contribute to vaccination barriers.

Temporal changes in factors associated with COVID-19 vaccine hesitancy among Chinese adults: Repeated nationally representative survey

BackgroundCOVID-19 vaccine hesitancy has been cited as one of the main obstacles impacting vaccine coverage. However, factors that affect hesitancy may change over time. Understanding these evolving concerns and adapting strategies accordingly are crucial for effectively addressing vaccine hesitancy effectively and promoting public health. We aimed to explore the temporal changes in factors associated with COVID-19 VH during the COVID-19 pandemic and assess the dynamic evolution of VH. MethodsIn August 2022 and February 2023, repeated online surveys were undertaken to collect information from 5378 adults across four regions of China. Multiple linear regression models assessed the influencing factors of COVID-19 VH. The association between protective motive theory (PMT) (perceived severity, susceptibility, benefits, barriers, and self-efficacy) and VH was evaluated by structural equation modeling (SEM). ResultsRepeated measures showed that 573 (10.7%) and 1598 (29.7%) of the 5378 participants reported COVID-19 VH in the baseline and follow-up surveys, respectively. Educational levels, chronic disease, history of allergy, COVID-19 infection, and trust in medical staff and vaccine developers were positively associated with COVID-19 VH (P＜0.05). The application of SEM revealed that perceived severity, susceptibility, vaccination barriers, and self-efficacy in the PMT directly impacted on VH (P＜0.05). In addition, severity, susceptibility, benefits, and barriers had a significant direct effect on self-efficacy as β = 0.113, β = 0.070, β = 0.722, β = −0.516 respectively with P < 0.001. ConclusionThe prevalence of COVID-19 VH was relatively low in the baseline survey and much higher in the follow-up survey, with a significant increase in hesitancy rates among mainland Chinese residents. Acknowledging the substantial impact on the shaping of COVID-19 VH, one must consider factors including perceived severity, susceptibility, vaccination barriers, and self-efficacy.

Awareness, Coverage, and Barriers to COVID-19 Vaccination among Undergraduate Students in Nigeria

Background: With the resumption of physical learning activities across Nigeria's higher education institutions, tertiary-level students, a priority group in the deployment of the COVID-19 vaccines according to the WHO SAGE, face circumstances that necessitate widespread vaccination coverage among them. This study aimed to assess Nigerian undergraduate students' knowledge, coverage, and barriers to COVID-19 vaccination. Method: A cross-sectional survey of Nigerian undergraduates was conducted in October 2021, using an online questionnaire and a combined simple random and snowballing sampling technique. The questionnaire included sections on respondents' demographic characteristics, COVID-19 vaccine awareness, coverage, barriers, and recommendations. A total of 326 respondents electronically completed and returned the informed consent form along with the questionnaire. The data obtained were analyzed using the statistical package for the social sciences (SPSS) version 25. Results: The overall awareness of COVID-19 vaccines among the sampled students was high; with 62.3%, 20.9%, and 16.9% having good, average, and poor levels of knowledge respectively. However, a majority of the respondents (81.3%) had not received the vaccines. The most prominent barrier to vaccination was misinformation about vaccine safety (23.6%). Opening vaccination centers on campuses (18.6%), demonstrating vaccine effectiveness and safety (18.7%), and organizing awareness campaigns (17.2%) were the most frequently recommended actions. Conclusion: Most respondents were aware of the availability and potential benefits of COVID-19 vaccines; however, coverage remained extremely low. Our findings emphasize the importance of addressing vaccination barriers by public health stakeholders to achieve optimal COVID-19 vaccine coverage.

A Short Review on Vaccine Barriers In Afghanistan

A Short Review on Vaccine Barriers In Afghanistan

Covid-19 vaccination among migrants in Rome, Italy

Migrants may be susceptible to vaccine barriers and hesitancy. We evaluated the association between migrant status, as measured by the citizenship from a High Migratory Pressure Country (HMPC), and COVID-19 vaccination uptake in the resident population in Rome, Italy. We also investigated sex differences. We followed participants for vaccination against COVID-19 in 2021. We calculated crude- and adjusted-vaccination rates and Cox hazard ratios of vaccination for migrants compared to Italians. Among migrants from HMPCs, we estimated HRs for females compared to males, stratifying by geographical area of origin. Models were adjusted for age and deprivation index and stratified by infection history. In 2021, among 1,731,832 18–64-year-olds, migrants were 55% less likely to uptake at least one COVID-19 vaccine dose than their Italian counterpart. Past SARS-CoV-2 infection reduced the difference between migrants and Italians to 27%. Among migrants from HMPCs, we observed a slight excess of vaccination uptake among females compared to males. Focusing on geographical areas, we observed that only females from central-western Asia were 9% less likely to uptake vaccination than males. Health communication strategies oriented to migrants and considering their different languages, cultures, and health literacy should be adopted for prevention before emergencies.

Reducing Barriers to COVID-19 Vaccination Uptake: Community Ideas from Urban and Rural Kenya

Following the rapid development of COVID-19 vaccines, addressing vaccine hesitancy and optimizing uptake have emerged as critical challenges, emphasizing the importance of reducing barriers toward COVID-19 vaccination. This study investigates ideas on ways to reduce barriers to COVID-19 vaccination uptake. It explores methods that can overcome COVID-19 vaccination barriers through qualitative research: interviews and group discussions involving healthcare providers, administration personnel, teachers, and individuals with chronic conditions across urban (Mombasa) and rural (Kilifi) Kenya. Audio-recorded discussions were transcribed and thematically analyzed across locations. Five themes emerged in our results regarding the reduction in barriers to COVID-19 vaccination in the context of Kenya, including awareness campaigns, engaging diverse stakeholders, using various communication techniques, capacity building to increase vaccination centers and trained staff, and lastly, revising relevant government health policies and guidelines. These results indicate the importance of adopting multiple approaches, as no single strategy can boost vaccine acceptance. Moreover, this study provides recommendations for conceiving actionable interventions to potentially boost vaccine demand and maintain routine immunization in Kenya.

RTS,S/AS01 malaria vaccine pilot implementation in western Kenya: a qualitative longitudinal study to understand immunisation barriers and optimise uptake

BackgroundMalaria is a significant public health threat in sub-Saharan Africa, particularly among children. The RTS,S/AS01 malaria vaccine reduces the risk and severity of malaria in children. RTS,S/AS01 was piloted in three African countries, Ghana, Kenya and Malawi, to assess safety, feasibility and cost-effectiveness in real-world settings. A qualitative longitudinal study was conducted as part of the feasibility assessment. This analysis explores RTS,S/AS01 vaccination barriers and identifies potential motivators among caregivers in three sub-counties in western Kenya.MethodsA cohort of 63 caregivers with a malaria vaccine eligible child was interviewed at three time points over 24 months. A sub-set of 11 caregivers whose eligible children were either partially or non-vaccinated were selected for this sub-analysis. The 5A Taxonomy for root causes of under-vaccination was used to organise the inductively-coded data into categories (awareness, acceptance, access, affordability, and activation) and identify the factors influencing uptake across caregivers. A trajectory analysis was conducted to understand changes in factors over time within each caregiver experience. Caregiver narratives are used to illustrate how the factors influencing uptake were interrelated and changed over time.ResultsLack of awareness, previous negative experiences with routine childhood immunisations and the burden of getting to the health facility contributed to caregivers initially delaying uptake of the vaccine. Over time concerns about vaccine side effects diminished and anticipated vaccination benefits strongly motivated caregivers to vaccinate their children. Persistent health system barriers (e.g., healthcare provider strikes, vaccine stockouts, negative provider attitudes) meant some children missed the first-dose eligibility window by aging-out.ConclusionsCaregivers in this study believed the RTS,S/AS01 to be effective and were motivated to have their children vaccinated. Despite these positive perceptions of the malaria vaccine, uptake was substantially hindered by persistent health system constraints. Negative provider attitudes emerged as a powerful deterrent to attending immunisation services and hampered uptake of the vaccine. Strategies that focus on improving interpersonal communication skills among healthcare providers are needed.

Analyzing an immunization resource website: User browsing trends

PurposeAccess to internet-based resources may help to improve population health awareness and literacy surrounding immunization related topics. The primary aim of this study was to evaluate and analyze trends for a single immunization resource website, the Melbourne Vaccine Education Centre (MVEC). Principal resultsOver a four-year period from 2019 to 2022, the website had over 2 million visitors from 236 countries. Users were predominantly female, in the 25 to 44 year age bracket and accessed resources using a mobile device.There was significant interest in specific vaccine related topics, particularly during the COVID-19 pandemic, that corresponded with key vaccine related recommendations and updates from a national level. Usage patterns saw spikes in interest around topics including COVID-19 vaccine administration techniques and adverse events following immunization. Major conclusionsUse of online platforms including websites such as MVEC may reflect trends and behaviors towards immunization related information. Analysis of usage patterns have provided user insights into key domains of interest including areas such as vaccine administration, policies and programs, vaccine safety and barriers to vaccine uptake.

Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19

BackgroundAdults with intellectual and developmental disabilities (IDD) experienced significant disruptions in their access to health care, support services, and essential daily activities such as work, leisure, and routine daily care during COVID-19. ObjectiveThe purpose of this study was to describe overall experiences related to COVID-19 among adults with IDD, including the vaccination process, quality of life (QoL), and service satisfaction before and during the pandemic. MethodsA longitudinal statewide survey of adults with IDD receiving long-term care support using a combination of self- and care partner report was completed prior to (2017; n = 331) and during (2021; n = 206) the pandemic. ResultsQualitative results identified specific vaccine barriers, vaccine decision influencers, and general experiences during COVID-19 for adults with IDD. The importance of support staff, vaccine availability, disruption in daily activities, social context, and mental health implications were noted in responses to all three topics. Quantitative results showed lower QoL during COVID-19 (M = 2.99 vs. 3.14, p = .028); however, when reporter (self vs. care partner) and age were added to the model, differences between pre-vs. during-COVID were no longer significant. No significant differences in satisfaction of services were noted pre-vs. during-COVID-19. Ninety-six percent of respondents reported access to the vaccine, and 16 % experienced barriers getting the vaccine. QoL was associated with receiving the COVID-19 vaccine (r = 0.15, p = .036), level of agreement that the vaccine is safe (r = 0.17, p = .024), and level of agreement that getting the vaccine will help protect other vulnerable people in the community (r = .25, p = .001). Level of satisfaction with quality of services was also associated with level of agreement that the vaccine is safe (r = 0.15, p = .048). ConclusionsOverall, a better understanding of service continuation, support practices, and experiences related to COVID-19 will prepare us for future environmental and health crises by identifying areas for improvement, intervention, and policy change to meet the ongoing needs of adults with IDD.

Covid-19 Vaccination Barrier Analysis in Five Selected Districts of Southern Province in Zambia

Background: To investigate the barriers that lead to people in the communities refuse to get vaccinated against COVID-19. There are perceptions that COVID-19 vaccines are surrounded with myths and misconceptions resulting in reduced vaccination rates. Therefore, this study was conducted to analyze COVID-19 vaccination barriers in communities and provide significant evidence for improved vaccination rates among eligible and vulnerable population.

Examining Influenza Vaccination Patterns and Barriers: Insights into Knowledge, Attitudes, and Practices among Diabetic Adults (A Cross-Sectional Survey).

Diabetes mellitus is a prevalent global chronic condition affecting individuals of all ages. People with diabetes face an elevated risk of lower respiratory tract infections such as pulmonary tuberculosis, influenza, and pneumonia. Additionally, the influenza virus increases the likelihood of deep venous thrombosis and pulmonary embolism. This study examined the knowledge, attitudes, and practices of diabetic patients regarding the influenza vaccine. This study involved 418 diabetic patients (53.3% female) at Jordanian outpatient respiratory clinics, with an average age of 49 (±14) years. The results showed that 70.6% had never received the influenza vaccine, and only 23.7% intended to do so in the current year. A positive attitude toward the influenza vaccine significantly reduced hesitancy to get vaccinated (OR = 0.505, 95% CI 0.424-0.601, p < 0.001). The duration of diabetes exhibited a positive association with vaccine hesitancy (OR = 1.053, 95% CI 1.006-1.102, p = 0.028). The primary reason for not getting vaccinated was a lack of awareness of its benefits (42.6%). Future health education programs should emphasize the importance of the influenza vaccine for diabetic patients and address their concerns.

Exploring COVID-19 Vaccine Misinformation Exposure, Beliefs, Fear, and Information Avoidance via the Stimulus–Organism–Response Framework

Empirical evidence generated from theory-driven research addressing the relationship between misinformation and vaccine information avoidance during a pandemic remains lacking. Using the Stimulus-Organism-Response (S-O-R) framework, this study examined the influence of vaccine misinformation exposure and information overload on cognitive and affective responses as well as vaccine information avoidance behaviors. Findings showed that misinformation exposure predicted cognitive health beliefs (perceived vaccination barriers and benefits) and negative emotions (fear) toward the vaccines; health beliefs in turn predicted information avoidance. Information overload moderated (a) the relationship between misinformation exposure and health beliefs and (b) the relation between misinformation exposure and fear.

“What should I do? We still have to go to work”: Latino immigrant perceptions of the COVID-19 pandemic and vaccine

PurposeThe COVID-19 pandemic disproportionately impacted Latinos across the United States though data on emerging immigrant communities is lacking. The purpose of this study is to better understand how Latino immigrants were impacted by the COVID-19 pandemic, allowing a community health clinic in Charlotte, North Carolina to quickly respond to their needs.Design/methodology/approachA mixed method, rapid appraisal using community-based participatory research approaches conducted in February to April 2021 by a team of bilingual researchers. Project consisted of a Spanish, electronic survey distributed through community leaders and in-person interviews conducted in Spanish at COVID-19 vaccine clinics. SPSS Version 26 was used for quantitative analysis. Ordinal and binary logistic regression tests were performed to assess the associations among several outcome and four predictor variables: documentation status, status of health insurance, level of trust in the vaccine and place of birth. Qualitative analysis used rapid appraisal and grounded theory approaches.FindingsLatino immigrants experienced job and income loss, resulting in difficulty paying for food, housing and health care. Participants experienced emotional and financial stress and isolation from family. Undocumented immigrants were more likely to experience detrimental impacts than documented immigrants. Most wanted the vaccine but felt barriers like trust and insurance may prevent them.Research limitations/implicationsFindings from this study are locally relevant to Latino immigrants living in the Charlotte area of North Carolina and findings may not be generalizable to other Latinos. Participants were recruited through faith networks and those who are not connected may not be represented. In addition, interview participants were sampled during vaccination clinics and likely had positive views of the vaccine.Practical implicationsAs a direct result of this project, community health clinic (CHC) held vaccination clinics to instill more confidence in the vaccination process. Spanish-speaking staff were available to assist with paperwork and answer questions onsite. The importance of familismo in decision-making and the reported presence of misinformation about the vaccine prompted CHC to continue providing accurate information about the vaccine in Spanish, and to strategize marketing materials to reflect a family-centric approach to better appeal to Latinos. Findings were used to obtain funding for expansion of clinical and behavioral health services in the community through mobile units, increasing accessibility for Latino immigrants.Originality/valueTo the best of the authors’ knowledge, this was the first study to examine the effects of the pandemic on a growing and disproportionately underrepresented group in an emerging immigrant state. Findings informed culturally competent COVID-19 vaccine clinics, marketing strategies and the expansion of medical and behavioral health services for a local community clinic.

A cross sectional survey on COVID-19 vaccination coverage at urban health center of a district in central Gujarat

Background: COVID-19 vaccination can lead to herd immunity when a sufficient proportion of population is vaccinated. Effectiveness of vaccination coverage depends on the population’s willingness to be vaccinated completely. Aim and objective was to estimate COVID-19 vaccination coverage and to determine reasons for its acceptance and non-acceptance in urban field practice area of medical college attached with tertiary care hospital. Methods: A cross-sectional house to house survey was conducted among the households (n=1346) under an urban health training centre (UHTC) of a medical college in central Gujarat after the second wave of COVID-19. All the beneficiaries above the age of 18 years residing in the house-holds coming under the field area were included in the study. The data was collected using Epi-collect 5 mobile based applications. Beneficiaries who had taken two doses of COVID-19 vaccine were counted as fully immunized. Vaccination coverage was calculated different for first and second dose. Facilitators and barriers for COVID-19 vaccination were shown with appropriate diagram. Results: Out of the 1832 participants in the survey, vaccination coverage was 78.22% for first dose and 37.23% for second dose. Most common motivation (81%) behind taking vaccination was “good health”. Among the non-users for COVID-19 vaccination, 36.8% did not take the vaccine due to fear of adverse reactions. Conclusions: Vaccination coverage is average in the urban area surveyed. Majority of the population is motivated to take the vaccine to protect themselves from COVID-19. The main reason for not taking vaccine was fear of side-effect of vaccine.

Determinants of COVID-19 vaccine uptake in the Netherlands: A nationwide registry-based study

Abstract Introduction By September 2022, uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies indicated lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination programme and generate hypotheses for research on drivers and barriers of vaccination. Methods A retrospective database study was performed including the entire Dutch population &amp;gt;18 years. Vaccination data (5 January 2021-18 November 2021) were at individual level linked to sociodemographic data. Voting proportions for political parties were added at neighbourhood level. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. Results The most important determinant for COVID-19 vaccine uptake was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years and 88% in those &amp;gt;80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower in individuals in the lowest income group (69%), receiving social benefits (56%), and individuals with two parents born abroad (59%). Conclusions Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. Lower uptake was found in individuals with lower income, lower socioeconomic status and a migration background. How to best address these inequalities for future vaccination campaigns requires further research. Key messages • COVID-19 vaccination likely contributed to increasing health inequity in the Netherlands. • Targeting vaccination efforts towards elderly aiming to maximise the impact of vaccination in reducing the burden of COVID-19 seems to be effective.

Development of a country specific flow chart to the effective vaccination of migrants in Italy

Abstract Background Achieving universal health coverage (UHC) is a key priority for promoting health equity. However, migrants face significant barriers to accessing health services, including vaccination. Within the “Access To Vaccination for Newly Arrived Migrants”(AcToVax4NAM) project (Grant No. 101018349, 3° EU Health Programme), this study aims to develop Italian country-specific action-oriented flow chart to overcome system barriers to the effective vaccination of newly arrived migrants (NAM). Methods Taking advances from AcToVax4NAM's prior research on vaccination barriers and solutions related to NAM immunization, Italian Professionals for Health (PfH) were engaged in participatory activities to ensure context-specific and relevant flow charts. The stakeholders invited were professionals working in Local Health Authorities (LHA), Non-Governmental Organizations and Universities. Two Focus Groups (FGs) were organized in order to validate and finalize the flow chart. Results A total of 29 PfH participated in the two FGs. The Italian country-specific flow chart resulted in a comprehensive approach to addressing barriers to effective vaccination of NAM in LHA. The flow chart includes steps such as entitlement, reachability, adherence, achievement and evaluation which are critical to ensuring vaccination coverage among migrants. A total of 58 tools also provides practical resources to support PfH in implementing the flow chart and addressing system barriers. Further evaluation of the impact of this flow chart on vaccination coverage and health outcomes is needed to assess their effectiveness and inform future efforts to improve health equity. Conclusions The development of Italian country-specific flow charts represents an important step towards achieving UHC and reducing health inequity among migrants. This flow chart and the tools identified to address the barriers have the potential to be a powerful support resources for equitable and guaranteed vaccination for NAM. Key messages • The Italian country-specific flow chart by addressing barriers to effective vaccination of NAM have the potential to significantly improve the health of migrants by reducing health inequity. • The AcToVax4NAM’s approach to creating context-specific flow charts ensures health equity for newly arrived migrants and their access to necessary vaccinations, promoting optimal health outcomes.

Perceived and functional parental health literacy and vaccine hesitancy among Cypriot parents

Abstract Background Assessing the association of perceived health literacy (PHL) and functional health literacy (FHL) with childhood vaccination hesitancy (VH) among parents is important in the context of developing targeted responses given that VH is of increasing public health concern. Methods A cross-sectional study was conducted with a convenience sample of parents of children, aged 6 months to 15 years old, presenting in pediatric primary care centers across 3 Cypriot cities. Participants responded to the HLS-EU-Q47 and the NVS (Newest Vital Sign), a self-rated and performance-based tool of health literacy (HL), respectively. They also completed a questionnaire tapping on attitudes and practices regarding childhood vaccinations. Parents were classified according to the overall and domain-specific PHL and FHL, and associations with VH were explored. Results Amongst 207 parents (82.6% female, 86.0% tertiary education), higher PHL was associated with certain positive attitudes and practices related to childhood vaccination e.g. childhood vaccination according to health science, whereas higher FHL appeared to be associated with certain negative attitudes and practices e.g. more concerns about side effects of vaccines. Lack of accurate information was the only reported vaccination barrier associated with lower PHL (34.28, SD = 7.54 versus 36.51, SD = 7.20 p = 0.04), whereas no vaccination barrier was associated with FHL. No significant associations between PHL and VH were observed. In contrast, higher FHL was associated with VH (p = 0.01) with parents categorized as ‘refusers’ (3.67, SD = 2.64) or ‘hesitant acceptors’ (3.15, SD = 2.74) having higher FHL than parents categorized as ‘delayers’ (2.95, SD = 2.63) or ‘non-hesitant acceptors’ (2.99, SD = 2.42). Conclusions Assessing both PHL and FHL led to a more comprehensive understanding on the influence of parental HL towards childhood vaccination which can guide the design and implementation of interventions to address VH among parents. Key messages • While parental HL is associated with childhood VH, a mixed pattern emerged depending on whether HL was operationalized using a perceived or functional measure. • While health education at clinical and population level are needed to counteract parental VH, the association of parental HL with childhood vaccination attitudes and practices is not straightforward.

Barriers and enablers to vaccine uptake in the Ultra-Orthodox Jewish population: a systematic review

Abstract Background The Jewish Ultra-Orthodox (UO) population is an undervaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases (VPD) such as measles and polio. Underlying reasons remain poorly characterized. We aimed to identify vaccination barriers and enablers in this population. Methods We systematically reviewed the literature, searching Pub-med, Web of science, Medline, PsychNet and Scopus from 1995 to 2021 for quantitative and qualitative primary research in English. We assessed included publications for quality and extracted relevant data based on the 5As taxonomy: access, awareness, affordability, acceptance and activation. Results We included 9 qualitative and 7 quantitative studies from the 125 studies identified. Access barriers included scheduling difficulties, inconvenient opening hours, and logistical difficulties related to having multiple young children. Acceptance barriers included safety concerns. Insufficient knowledge about the importance of vaccines and timely vaccination and the perception of being shielded from infections because of seclusion from wider society were key awareness barriers. Competing priorities, such as work and housework, were the main affordability barriers. Mainstream religious leadership's support for vaccination was an enabler, although recent studies suggest their influence on vaccination behavior is decreasing and the influence of anti-vaccination messages is growing. Conclusions Barriers to vaccination among the UO were mainly logistical, with little religious framing. Safety and efficacy concerns were similar to those reported in the wider community. Decreasing influence of the traditionally pro-vaccine mainstream religious leadership and growing influence of anti-vaccination movements targeting the UO community are new phenomena that require close monitoring. Tailored interventions are required to protect the community and wider society against future VPD outbreaks. Key messages • Vaccination barriers in Ultra-Orthodox Jewish communities are due mainly to logistical challenges, such as competing priorities in large families with young children. • Religious leadership is the main enabler of vaccination in Ultra-Orthodox Jewish communities, but their declining authority and exposure to antivaxx materials is causing a shift in attitudes.