Vaccination Delay Research Articles

Courage in Decision Making: A Mixed-Methods Study of COVID-19 Vaccine Uptake in Women of Reproductive Age in the U.K.

COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct-Dec 2021: 3453 responders; Aug-Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.

“Your child will have a bird brain!”: Vaccination choices and stigma among vaccine enquirers in Sweden: A qualitative study

BackgroundSubstantial research has explored reasons for vaccination delay or refusal. However, little attention has been paid to the process and implications of the choices. The aim of this research was to understand parent's vaccination choices and implications of their choices through the lens of the concept of stigma and health behaviours. MethodsThis is a qualitative study drawing on five focus group discussions and 17 in-depth interviews. Data was collected in an area South of Stockholm that has experienced lower rates of vaccination and is home to some people who are partly inspired by anthroposophical values. The data was analysed following reflexive thematic analysis. Results(1) Vaccine enquirers make an informed decision about their vaccination choices. They negotiate different sources, question science, ask for more information and are largely content with their decision. (2) Values and norms influence vaccination decisions; these include anthroposophical health beliefs, and they partly influence the way in which risk is balanced. Trust influences vaccination decisions but trust expresses itself in complex ways. (3) Vaccination related stigma; expressed through fear of being labelled, conflicts with family and friends, feeling lonely with the decision, and avoidance to discuss vaccination choice. (4) Vaccination related stigma was found in the healthcare setting too, expressed by participants working in the health system as well as parents who experienced disrespect and labelling when expressing vaccine choices or seeking healthcare with an unvaccinated child. Participants describe their community as a safe haven where different vaccination choices are respected. ConclusionThe study found that vaccine enquirers are individuals who make an active choice to delay or decline vaccination. They are not uncertain or hesitant but rather consider themselves well-informed. The study also found different forms of stigma related to vaccination choices. Further research may be helpful to understand implications of vaccination related stigma on health and other vaccination decisions.

A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis.

Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a "snapshot" of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities.

Abstract 810: Assessing human papillomavirus (HPV) awareness and intentions to participate in HPV vaccination and clinical trials (CT) among Latinos/as in Los Angeles (LA) County: A multicomponent intervention

Abstract Background: The incidence of HPV-related cancers continues to disproportionately affect women and men of Latino origin. In LA, a total of 20,868 individuals have been diagnosed with HPV-related cancers from 2009 to 2019. HPV infection knowledge and interpersonal barriers contribute to HPV vaccine delay and refusal. Similarly, Latinos/as continue to also have low participation in clinical trials research. To address the low knowledge, attitudes, and intentions towards HPV vaccination and participation in clinical trials (CT), we have adopted the NCI National Outreach Network framework and have used community health educators to deliver bilingual-culturally appropriate workshops on HPV and CT. Methods: Individuals, 18 and over and parents with eligible age children (in respect to the HPV initiative) were recruited through community outreach and local community partnerships to participate in the bilingual (English and Spanish) health education workshops. A baseline assessment was administered before each educational workshop and a follow-up assessment was administered after to evaluate change in HPV and CT knowledge, intentions to vaccinate, and likelihood to participate in CT. Descriptive statistics were calculated to assess distribution of demographic variables of interest and a paired T-test was used to explore matched pre-post differences in knowledge scores and intentions. Results: 290 (HPV) 272 (CT) individuals participated in the workshops. The mean age of participants was 41.13yrs with a (SD=11.63). More than half of participants were women 453 (81.7%), men 94 (16.9%) and other 7 (1.26%). Comparing HPV knowledge scores of matched pre-and post-surveys, showed that for baseline (n=182) (M=72.9%, SD=13.3) was statistically different from post-scores (n=182) (M=81%, SD=9.85) where p&amp;lt;0.05. Intentions were measured using a Likert scale, baseline (M=4.1), agree to get HPV vaccine, post (M=4.5) strongly agree to get HPV vaccine. In respect to CT baseline knowledge (n=174) (M=75.3%, SD=0.15), following a Likert scale response of (M=3.4), unsure to join a clinic trial. In assessing post-CT scores (N=174) (M=78%, SD:0.14), mean scores were significant where p&amp;lt;0.05 and an increase to (M=3.7) agree to join a clinical trial. After workshops attendance, not only was knowledge increased, but intentions to vaccinate against HPV and to participate in a clinical trial was strengthen. Conclusions: Strengthening community-based education and providing the necessary tools, can help reframe misconceptions about HPV and HPV vaccination and promote willingness to vaccinate and participate in clinical trials. Citation Format: Alejandra Ramos, Carolina Aristizabal, Lourdes A. Baezconde-Garbanati. Assessing human papillomavirus (HPV) awareness and intentions to participate in HPV vaccination and clinical trials (CT) among Latinos/as in Los Angeles (LA) County: A multicomponent intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 810.

Improving COVID-19 Vaccine Uptake in Saskatchewan, Canada: A Developmental Evaluation Approach

Background The Developmental Evaluation of a COVID-19 vaccination program was an early response to assess a complex emergent mass vaccination program to support learning and adaptation. Objective The primary objective of a multi-disciplinary team of researcher-evaluators was to facilitate organizational learning among key stakeholders to improve decision-making and increase vaccine uptake in Saskatchewan, Canada. Methods Aligned with the Developmental Evaluation approach, data collection was rooted in adjustment and flexibility to meet the evolving needs of the vaccination program. Data were primarily collected using meeting observations and program documentation. As the program progressed, the data collection was adjusted, and two surveys were conducted targeting COVID-19 vaccine recipients and vaccine immunizers. Data were analyzed iteratively in consultation with stakeholders. Results Nine feedback reports were generated over a nine-month evaluation period. Seven reports highlighted meeting observation results that revealed the program issues, probable causes, and implications. The evolving issues ranged from vaccine shortage, delay, and supply fluctuation to inter-organizational miscommunication and vaccine hesitancy. Two reports were produced from survey findings to delve into the persistent issue of vaccine hesitancy. Conclusion Effective solutions to complex issues of Saskatchewan’s COVID-19 mass immunization require a systems approach based on new ways of thinking and collective decision-making.

The Impact of the COVID-19 Pandemic on Cancer Patients’ Access to Diagnostic and Treatment Services in Kerman Province: A Qualitative Study

Background: Pandemics affect patients’ access to diagnostic and treatment services. As cancer patients need regular follow-up, any obstacle in accessing services can affect the conditions of these patients. Therefore, this study was conducted to investigate the effects of the COVID-19 pandemic on cancer patients’ access to diagnostic and treatment services. Methods: In this qualitative study, 15 people were selected through a targeted sampling method among the patients who were referred to cancer treatment centers in Kerman. The interviews were semi-structured and face-to-face and were conducted in April 2021. The data were analyzed using directed content analysis. Results: Among the people included in this study, 10 (66.7%) were women and more than half of the investigated people were in the 36 to 55 years age group (53.3%). These patients faced challenges including delay in treatment, mental and psychological problems, financial problems, and delay in COVID-19 vaccination. Conclusion: Various challenges and factors play a role in cancer patients’ access to diagnostic and treatment services during the pandemic. Therefore, more physical space should be allocated to them in treatment environments to reassure them and facilitate their timely referral to doctors. In addition, psychiatric consultations to identify the problems of cancer patients and regular follow-up of these patients can reduce their problems during pandemics such as the COVID-19 pandemic.

Human Papillomavirus (HPV) Vaccine Coverage and Confidence in Italy: A Nationwide Cross-Sectional Study, the OBVIOUS Project.

Human Papillomavirus (HPV) vaccination rates are still below the target due to vaccine refusal or delay, lack of knowledge, and logistical challenges. Understanding these barriers is crucial for developing strategies to improve HPV vaccination rates. This cross-sectional study used a questionnaire to investigate social and behavioral factors influencing decision making about the HPV vaccine. The survey was conducted from 11 April to 29 May 2022 and involved 10,000 Italian citizens aged ≥ 18 years. The sample was stratified based on region of residence, gender, and age group. 3160 participants were surveyed about themselves, while 1266 respondents were surveyed about their children's vaccine uptake. Among females aged ≥ 26 years, the national average HPV vaccine uptake was 21.7%, with variations across different regions. In the 18-25 age group, females had a vaccine uptake (80.8%) twice as much as males (38.1%), while vaccine uptake among male and female children aged 9-11 was similar. The OBVIOUS study in Italy reveals factors influencing low HPV vaccine uptake, suggesting targeted approaches, tailored information campaigns, heightened awareness of eligibility, promoting early vaccination, addressing low-risk perception among males, addressing safety concerns, and enhancing perceived accessibility to improve vaccine uptake and mitigate health risks.

Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo.

The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.

Between now and later: a mixed methods study of HPV vaccination delay among Chinese caregivers in urban Chengdu, China

BackgroundAdolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls.MethodsQuantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen’s Behavioural Model for Health Services Use.ResultsA total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active.ConclusionIn urban areas, Chinese caregivers’ intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents.

Vaccination coverage and delay in vaccination of infants born in 2017 and 2018 in municipalities in the Southern region of Brazil: National Vaccination Coverage Survey 2020.

To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages. Vaccination coverage for the set of vaccines recommended up to 24 months was 68.0% and 3.9% for on-time doses. Delay time for some doses exceeded six months in up to 25% of infants with delayed vaccination. Monitoring vaccine administration at the recommended ages is necessary, with the adoption of strategies that reinforce routine vaccination to prevent vaccination delays and abandonment. Primary care in surveillance and care for infants needs to reinforce actions to ensure timely vaccination. Studies to deepen knowledge of vaccination delay, determinants and strategies for their reduction are necessary.

Vaccination coverage and delay in vaccination of infants born in 2017 and 2018 in municipalities in the Southern region of Brazil: National Vaccination Coverage Survey 2020

RESUMO Objetivo Avaliar as coberturas vacinais e o atraso nas doses de vacinas em lactentes em seis municípios da região Sul do Brasil. Metodologia Inquérito Nacional de Cobertura Vacinal 2020, com lactentes nascidos vivos em 2017 e 2018, realizado entre setembro de 2020 e março de 2022. Foram avaliadas as coberturas de doses aplicadas, doses em dia e o tempo de atraso da aplicação. Resultados Para 4.681 lactentes analisados, as coberturas para vacinas indicadas até os 24 meses foram de 68,0% (IC95% 63,9;71,8) para doses aplicadas e 3,9% (IC95% 2,7;5,7) para doses em dia. A maioria das aplicações em atraso foi ≤ 3 meses. Para alguns reforços, 25% das aplicações atrasaram ≥ 6 meses. Conclusão Além da busca de faltosos às vacinas, são necessárias estratégias para estímulo ao cumprimento do esquema de vacinação nas idades preconizadas.

Family Structure Associated with Measles-Rubella and Varicella Vaccination in Children.

Delayed vaccination is a well-studied and critical public health issue. However, limited studies have explored whether familial factors influence vaccination delay. This study aimed to determine whether family structure and comorbidities affect the refusal or delayed receipt of measles-rubella and varicella vaccines. We gathered data on all children from birth to 13 months of age between 2006 and 2020 using vaccination records linked with the administrative healthcare claims data from a Japanese city. Multivariable logistic regression analyses were conducted to examine the association of refusal or delay in receiving the first-dose measles-rubella and varicella vaccines with the following factors: the child's sex; presence of parents, siblings, and grandparents; parental and grandparental comorbidities; chronic pediatric comorbidities in the child and siblings; and year of vaccination. We identified a total of 14,241 eligible children. Refusal or delayed receipt of the first-dose measles-rubella vaccine was associated with an adjusted odds ratio of 2.46 (95% confidence interval, 1.86-3.24) for maternal absence and 1.61 (1.44-1.80) for paternal absence. Similarly, the refusal or delay in receiving the first-dose varicella vaccine was associated with an adjusted odds ratio of 2.04 (95% confidence interval, 1.01-4.16) for maternal absence and 1.37 (1.12-1.69) for paternal absence. The presence of siblings and maternal comorbidities were significantly associated with vaccination delays. The absence of a parent, the presence of siblings, and maternal comorbidities were associated with the refusal or delay in receiving measles-rubella and varicella vaccines. Strategies for vaccine recommendation should therefore consider family structure and maternal comorbidities.

Repercussões da COVID-19 no cuidado às crianças com necessidades de saúde especiais

Abstract Objective Understanding the repercussions of the COVID-19 pandemic on the care of children with special health needs. Methods Exploratory, qualitative research, anchored in the conceptual framework of health vulnerability in the individual, social and institutional dimensions. Interviews were carried out from October 2020 to February 2021 (pre-vaccination against COVID-19) with 19 family caregivers, 11 professionals from education, social protection and health institutions and 15 primary health care nurses in a Brazilian city on the Brazil-Argentina-Paraguay border. Reflective thematic analysis was applied. Results Discontinuity in care, low scope of social protection and unstable institutional context marked the attention of children with special health needs. Individual vulnerabilities were highlighted as a result of vaccination delays, fear of contagion and changes in development; institutional vulnerability due to restrictions on home visits, waiting lists, lack of professionals and absence of group activities; and social vulnerability related to difficulties in social assistance and the closure of land borders. Elements related to the telehealth strategy and mechanisms that assume professional responsibility expressed strengths for the care of children with special health needs. Conclusion The restrictive measures adopted at the beginning of the COVID-19 pandemic had a negative impact on the care of children with special health needs, intensifying their individual and social vulnerabilities. Strengthening family and community contexts and expanding dialogue between sectors of primary health care indicate avoiding a mismatch between professional support and the pressing needs of these children, ensuring continuity of care.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Users' perception of hesitancy and delay in vaccination in Primary Health Care

Introduction: Vaccination is an extremely important and necessary act from the beginning of a human being's life. Aim: Unveil users' perception of the reasons for hesitancy and delay in vaccination. Outlining: This is an exploratory-descriptive study with a qualitative approach, through the application of a semi-structured interview with users (51) of the Basic Health Units (UBS) in the city of Tianguá – CE, data collection was carried out between November and December 2021, the interviews were transcribed, Bardin's content analysis technique (2016) was used to organize data and the results were presented with the help of the Iramuteq™ software. Results: four thematic categories were identified: 1 – Fear and dread of the adverse effects is a factor in the vaccine refusal, 2 – Challenges in ensuring user accessibility to vaccines, 3 – Users' distrust about the benefits of vaccines and 4 – Lack of information and understanding about the effects of non-adherence to vaccination. It was then found that hesitancy and/or refusal to get vaccinated is motivated by multifactorial aspects, which can influence users' decisions individually or jointly. Implications: Health professionals play a key role in promoting vaccination, being a preferred source of information indicated by users.

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.

Childhood immunization delay during the first wave of COVID-19 in an urban area of Sangli district from Maharashtra, India: a cross-sectional study

BackgroundCOVID-19-related lockdowns had resulted in overburdening on health services. The lockdowns along with anxiety of the disease have resulted in delay in routine vaccination of many under-5 children. The current study was undertaken to understand the extent of the delay in under-5 vaccination during COVID-19-related lockdown in March-December 2020.MethodsIt was a cross-sectional study conducted during January-December 2021. Study population was under five children due for vaccination during the first COVID-19 lockdown at March-December 2020. Vaccination cards were used to confirm the status of vaccination, and questionnaire was used to study the attitude of parents towards vaccination and reasons for delay in vaccination, if any. The calculated sample size was 1434. But cluster random sampling method was applied; hence, 2274 subjects were included in the study. Statistical analysis was done using IBM SPSS-22™, using descriptive statistics and chi-squared test.ResultsPercentages of children with delayed vaccination ranged from lowest for “at birth dose” (12.47%) to highest for “9th month dose, i.e. MR vaccine” (54.29%). Majority of parents stated lockdown and risk of COVID-19 infection as to be reason of the delay in vaccination. There was no uniform association between vaccination delay and attitude of parents towards vaccination.ConclusionCOVID-19 pandemic and subsequent lockdown are the reasons stated by majority of parents with delayed vaccination in their children. This could be important lesson to plan for such contingencies for developing health services in future.

Impact of COVID-19 pandemic on immunisation services performance in Sharqat, Saladin Governorate, Iraq

Objective: To determine the frequency of vaccination delays and the causes of such delays during the coronavirusdisease-2019 pandemic.Method: The cross-sectional study was conducted from December 15, 2020, to July 20, 2021, at health centres in theSharqat area of Saladin Governorate in Iraq, and comprised parents who brought their child for immunisation duringcoronavirus disease-2019 pandemic. Data was gathered via direct interviews using a pre-designed questionnaire.Data was analysed using SPSS 19.Results: Of the 150 respondents, 84(56%) were from urban areas, and 65(42%) had higher education levels. The associationwas significant with level of education, socio-economic status of the family and availability of transportation (p&lt;0.05).Conclusion: The vaccination process got disrupted during the coronavirus disease-2019 pandemic in Iraq.Keywords: COVID-19, Pandemic, Immunisation, Performance.

Delays in the vaccination of infants between 2 and 18 months of age: associated factors in Chile

IntroductionInfant vaccination has significantly reduced the morbidity and mortality of transmittable diseases worldwide. Its coverage is high (85%); however, partial or suboptimal vaccination has been an important public health problem. This study aimed (1) to design and explore the psychometric features of a questionnaire to determine the reasons for this partial or suboptimal vaccination; and 2) to determine the factors associated with delaying Diphtheria, Tetanus, Poliomyelitis (DTaP) vaccination.Material and methodsThis study contained two parts. In Part One, a questionnaire was created by the research team and then validated by a committee of experts in the field and a group of parents. It included the following contents: sociodemographic variables, features of the vaccination services, history of vaccination, and attitudes and perceptions about vaccination. Part Two was a cross-sectional study, recruiting private and public healthcare centers to explore the psychometrics features of the instrument, performing exploratory factor analysis, and determining the associated factors with DTaP vaccination delay throughout multivariable regression models.ResultsInitially, six experts validated the questionnaire. For instance, on a scale of 1 to 5, the general evaluation of the questionnaire was ≥ 4 for all the experts. Additionally, five experts considered that most of the questions were easy to understand, and all thought the questionnaire had a clear and logical organization. The resulting questionnaire included the “Trust and positive attitude towards vaccination” scale, which had a good structure of items and internal consistency (α = 0.7918). Six healthcare centers were recruited in the second part of the study, and 715 people answered the questionnaire. Not being the mother who brings the child to the health center, having more than one child, and having a history of previous vaccination delays increased the risk of delaying vaccination. Attending the healthcare center for a reason other than only vaccination, obtaining information about vaccines from the Internet, and having higher trust and positive attitudes to vaccination reduced the risk of delay.ConclusionsFirst study during the pandemic to explore the role of different factors on the risk of DTaP vaccination delay in Latin America. The findings highlighted the importance of trust in the vaccination system. The instrument presented in this article may help the scientific community evaluate future interventions to increase trust and positive attitudes toward the vaccination process.

Lessons learned from COVID-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy

BackgroundEnhancing the public's vaccine literacy is critical for curbing vaccine hesitancy and enhancing society's pandemic preparedness, particularly in an era of infodemic. Evidence on vaccine literacy as an influencing factor of hesitancy is scarce. Lessons could be learned from COVID-19 vaccination implementation. Taking the COVID-19 vaccines as an example, the current study aimed to examine the relationship between vaccine literacy and hesitancy and the mediating role of psychological antecedents of vaccination on the relationship. MethodsA baseline online questionnaire survey among the general public in China based on quota sampling was conducted in April 2021 to measure participants' vaccine literacy, psychological antecedents of vaccination, COVID-19 vaccination status, and vaccine hesitancy. A follow-up online survey tracked the updated COVID-19 vaccination status among those who hadn't taken COVID-19 vaccines at the baseline survey. Structural equation modeling has been applied to examine the direct and indirect effect of vaccine literacy on vaccine hesitancy. Time-to-event analysis was used to explore the effect of vaccine hesitancy on vaccination behavior. ResultsLower vaccine hesitancy was associated with higher vaccine literacy. The "3Cs" psychological antecedents were important mediators between vaccine literacy and vaccine hesitancy. The pathway between critical/interactive vaccine literacy and vaccine hesitancy through the "3Cs" psychological antecedents played a more important role. Time-to-event analysis showed participants with a higher vaccine hesitancy were prone to have a longer delay in vaccination. ConclusionsImproving the public's ability to obtain and evaluate vaccination information can fix the public's psychological determinants of vaccination, reducing vaccine hesitancy and promoting vaccination. Governments need to put more effort into guiding and regulating the media to disseminate evidence-based information, rectifying misinformation, and improving the public's vaccine literacy through education, especially the public's capability to critically discern mixed information.