Vaccine-related Attitudes Research Articles

How early onset of COVID-19 changed vaccine-related attitudes: A longitudinal study

The paper investigates how the onset of the global COVID-19 pandemic has influenced the attitudes and beliefs of a previously anti-vaccine and vaccine-undecided population: how it changed their anti-vaccine beliefs and related arguments, perceptions of scientists’ credibility, as well as what their beliefs about COVID-19 are and what protective action they undertake against it. We used preexisting data from a 2018 study, where we identified groups of anti-vaccine and vaccine-undecided individuals (N = 365) whom we reached out to again in April/May 2020 (during the first months of the pandemic, when no COVID-19 vaccine was available). An online survey was used to measure changes in attitudes toward vaccination, reasons for vaccine rejection, attitudes toward scientists, and (at Measure 2) to measure attitudes toward COVID-19 and protective action against it. Results indicated a general pro-vaccine shift in attitudes, as well as reduced support for all anti-vaccine arguments. Surprisingly, we also found a negative shift in the sample’s perceptions of scientists’ agency and communion. Anti-vaccine individuals were also much less likely to employ any protective measures and had the lowest levels of fear associated with COVID-19. These results show that the initial stages of the COVID-19 outbreak caused a positive change in vaccine attitudes, especially in the vaccine-undecided group. At the same time, strongly anti-vaccine individuals were likely to reject protection against COVID.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany.

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

Trust and needles: how perceptions of inequality shape vaccination in South Korea

This study investigates the influence of perceived inequality on vaccination behaviors within the social context of South Korea. It explores how perceptions of inequality affect trust in science and society, subsequently impacting vaccination behaviors. The first analysis utilizes path analysis to identify both direct and indirect effects of perceived inequality on COVID-19 vaccine-related attitudes, mediated by trust in science and society. This provides foundational insights into these relationships at the individual level. The second analysis expands the scope to district-level data, analyzing influenza vaccination records from 2015 to 2021 to validate and enhance the initial findings. These results suggest that the public uses perceptions of inequality and regional economic disparity as heuristics in vaccination decisions. This study contributes to academic discourse by elucidating factors influencing vaccination behavior. It highlights the critical role of subjective sense of inequality in shaping public health policy, especially in response to emerging infectious diseases and future pandemics.

Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

BackgroundBefore, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating. ObjectivesTo study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy. DesignA cross-sectional survey. SettingsSalaried, community (self-employed) and mixed nurses in France. Participants18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323). MethodsIn February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors) a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults). ResultsAmong the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10−3) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10−3) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses. ConclusionsSatisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.

Validity and Reliability of the Greek Version of Adult Vaccine Hesitancy Scale in Terms of Dispositional Optimism in a Community-Dwelling Population: A Cross-Sectional Study.

Vaccine hesitancy is an important public health issue referring to concerns about the safety and efficacy of vaccination. Within a framework, this study aimed to assess the cultural adaptation, validity, and reliability of the Greek version of the adult Vaccine Hesitancy Scale (aVHS) as well as to identify the determinants of vaccine hesitancy among a large regional population in central Greece. A cross-sectional study was conducted enrolling 300 adults who had received primary healthcare services in the Health Centers and Local Health Units of the Magnesia Region from October to December 2022. The aVHS and the Life Orientation Test-Revised (LOT-R) were used to identify vaccine hesitancy and the dispositional level of optimism, respectively. For survey translation, the procedure of forward and backward translation was followed. Also, the aVHS was tested in a pilot study with a sample of 18 responders. Construct validity and internal consistency reliability were investigated via exploratory and confirmatory factor analysis and Cronbach's alpha coefficients, respectively. Simple and multiple linear regression analysis were used to determine predictors for vaccine hesitancy. Factor analyses indicated that the aVHS comprises two constructs ("lack of confidence" and "risk perception") explaining 68.9% of the total variance. The Cronbach's alpha of the total scale was 0.884, indicating its high internal consistency. Participants who lived in rural areas, had a lower annual income, and reported a lower level of optimism showed a higher lack of confidence in vaccination. On the other hand, people aged above 45 years old who had graduated from high school or elementary school and were unemployed showed greater aversion to the risks of side effects. Finally, certain socio-demographic characteristics were associated with vaccine hesitancy. Our data suggest that the aVHS is a valid and reliable instrument for measuring vaccine-related attitudes and perceptions in Greek society, providing meaningful insight into designing vaccination-related preventive interventions in the community.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19.

Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake. The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted. Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents. Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

COVID-19 Vaccine Acceptance, Hesitancy, and Uptake in People with Diabetes in Australia.

Background: This study explored vaccination hesitancy, diabetes-specific COVID-19 vaccination concerns, and whether they predicted vaccination uptake in people with diabetes. Methods: Quantitative, cross-sectional, and predictive approaches were used. An online survey was conducted with people with diabetes attending four Australian health services, using convenience sampling (n = 842). The survey data collected included clinico-demographic characteristics, COVID-19 vaccine hesitancy, and attitudes around COVID-19 vaccine confidence and complacency. Clinico-demographic characteristics that predicted vaccination status, vaccine hesitancy, and vaccine-related attitudes were identified using regression analyses. Results: Most participants received at least one COVID-19 vaccine dose. Younger age and type 1 diabetes were associated with lower vaccination status, and they were partially mediated through higher vaccine hesitancy. Younger age and English as a dominant language were associated with higher negative attitudes towards speed of vaccine development. Conclusions: Despite an overall high vaccination rate, general and diabetes-specific COVID-19 vaccine concerns are a barrier to uptake for some people with diabetes, particularly in those who are younger or have type 1 diabetes. A detailed understanding of concerns for particular subgroups can help tailor information to increase vaccine acceptance, particularly in the context of requiring booster doses.

Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi

This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi’s three districts of Zomba, Dowa and Nkhatabay. Results showed that 163 (41.4%) participants had low levels of knowledge of COVID-19 vaccine, 231 (58.6%) had high levels of knowledge, 237 (60.2%) had a positive attitude, and 156 (39.8%) had a negative attitude towards the COVID-19 vaccine. On vaccine uptake, the study found that only 29 (17%) male and 52 (23%) female participants had received the vaccine. Further, participants with low levels of knowledge and a positive attitude towards the vaccine were 5.9 times more likely (p-value = 0.001) to be vaccinated than those with low levels of knowledge and negative attitudes towards the vaccine. On the other hand, those with high knowledge and a positive attitude towards the vaccine were 8.2 times more likely (p-value < 0.001) to be vaccinated compared to those with low knowledge and negative attitudes towards the vaccine. The findings highlight the importance of vaccine-related knowledge and attitudes in shaping uptake and reveal disparities across demographic groups. To improve vaccination coverage in Malawi, targeted interventions focusing on enhancing COVID-19 vaccine knowledge, addressing attitudinal barriers, and countering misinformation are needed. Strategies should be tailored to reach populations with lower uptake, such as males, younger adults, and those with lower education levels. Strengthening public health messaging, engaging community leaders, and building trust in healthcare systems are crucial for promoting widespread acceptance and uptake of COVID-19 vaccines in Malawi.

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States: The contribution of vaccine-related attitudes

ObjectiveRacial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States have been documented. This study assessed the contribution of vaccine-related attitudes to coverage disparities. MethodsSurveys were conducted following the 2019–2020 and 2020–2021 influenza seasons in a US research network. Using electronic health record data to identify pregnant women, random samples were selected for surveying; non-Hispanic Black women and influenza-unvaccinated women were oversampled. Regression-based decomposition analyses were used to assess the contribution of vaccine-related attitudes to racial and ethnic differences in influenza vaccination. Data were combined across survey years, and analyses were weighted and accounted for survey design. ResultsSurvey response rate was 41.2% (721 of 1748) for 2019–2020 and 39.3% (706 of 1798) for 2020–2021. Self-reported influenza vaccination was higher among non-Hispanic White respondents (79.4% coverage, 95% CI 73.1%–85.7%) than Hispanic (66.2% coverage, 95% CI 52.5%–79.9%) and non-Hispanic Black (55.8% coverage, 95% CI 50.2%–61.4%) respondents. For all racial and ethnic groups, a high proportion (generally >80%) reported being seen for care, recommended for influenza vaccination, and offered vaccination. In decomposition analyses, vaccine-related attitudes (e.g., worry about vaccination causing influenza; concern about vaccine safety and effectiveness) explained a statistically significant portion of the observed racial and ethnic disparities in vaccination. Maternal age, education, and health status were not significant contributors after controlling for vaccine-related attitudes. ConclusionsIn a setting with relatively high influenza vaccination coverage among pregnant women, racial and ethnic disparities in coverage were identified. Vaccine-related attitudes were associated with the disparities observed.

COVID-19 vaccination attitudes, values, intentions: US parents for their children, September 2021

ObjectivesTo compare vaccine-related attitudes and values of parents of children 2–17 years old to other adults, examine intentions to vaccinate their children, and identify factors associated with intending to vaccinate children. MethodsA nationally representative survey was conducted in September 2021 (just before the EUA for children 5–11 years old) using Ipsos KnowledgePanel, a probability-based web panel. The survey measured COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities among US adults. Scale response options to survey items were dichotomized, and cross-tabulations and logistic regressions were performed. ResultsParents had lower odds of reporting being vaccinated against COVID-19 than other adults even after adjusting for associated sociodemographic characteristics such as age (aOR: 0.66; 95 %CI: 0.50–0.87). The most prevalent parental concerns about COVID-19 vaccines included the speed of their development (88 %), potential side effects (78 %), suspicion of government (77 %), and suspicion of pharmaceutical companies (72 %). Fewer than half (42 %) of parents intended to vaccinate their children 5–11 years old, while 38 % were uncertain and 20 % were unlikely to ever vaccinate their children. Vaccinated parents had higher odds than unvaccinated parents of intending to vaccinate their children (OR: 675.51; 95 %CI: 106.46–4286.12). Discussions with healthcare providers who encouraged COVID-19 vaccination were positively associated with intent to vaccinate children (OR: 11.29; 95 %CI: 2.60–49.02). ConclusionsWe found parental vaccination and conversations with providers were positively associated with intent to vaccinate children. Decisions about childhood vaccination need to be supported by healthcare providers and a public health system that makes vaccine access and related information equitable and accessible. Vaccination-related decision making should be guided by healthcare providers and provide information about safety and risk to children.

Touching the cornerstone: An illustrative example of the effects of stigma and discrimination on vaccine-hesitant parents

ObjectivesThe concept of vaccine hesitancy encompasses multiple views on the subject. However, there has been an increasing polarization of the discourse on vaccine hesitancy leading to the stigmatization of those parents who expressed doubts or concerns regarding vaccination practices. The present study aimed to explore the drivers and consequences of polarized discourses on vaccination in the Portuguese context. This paper is part of a broader study which aims to gain a deeper understanding about the phenomenon of vaccine hesitancy at the European level. Study designA qualitative research design was used. MethodsThe sample was comprised of thirty-one Portuguese vaccine hesitant parents who were interviewed. A thematic analysis of the transcribed interviews was performed which allowed us to identify key themes. ResultsThe results showed that the labelling of vaccine-hesitant parents as ‘anti-vaxxers’ along with social media play a crucial role in promoting the polarization of vaccine-related attitudes. The stigmatization of vaccine hesitant parents has a disruptive impact on their social network leading them to search for online platforms where they can exchange vaccines-related information without being discriminated. ConclusionsThe stigma and discrimination experienced by vaccine-hesitant parents stimulated that hesitancy becomes more entrenched. Therefore, pluralism should be used to tailor vaccination promotion campaigns to different targets, promoting its reach and efficacy.

Digital storytelling intervention to promote HPV vaccination among at-risk Asian immigrant populations: Pilot intervention study.

The high morbidity, mortality, and economic burden attributed to cancer-causing HPV call for researchers to address this public health concern through human papillomavirus (HPV) vaccination. Despite disparities in HPV-associated cancers in Korean and Vietnamese Americans (KAs, VAs) their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (DST; a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Study aims were to assess the preliminary effects of an innovative remotely delivered culturally and linguistically congruent DST intervention consisting of stories of personal lived experiences on KA and VA mothers' attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by child's sex (boy vs. girl) and by ethnicity (KA vs. KA). Participants were recruited from via multiple outlets (e.g., ethnic minority community organizations, social media, flyers posted in local Asian supermarkets and nail salons). Valid and reliable measures were administered online to collect data pre- and post-intervention. Statistical analysis including descriptive statistics, paired and independent sample t-tests, chi-square, and McNemar's test were used to describe the distributions of variables and to examine differences between subgroups and changes in key variables over time. We estimated logistic regression models to examine associations between mother's HPV- and vaccine-related attitudes and vaccination intention, and to explore if the association between attitudes and vaccination intention differed by the target child's sex or ethnicity. In our sample of 50 KA mothers (mean age = 42.8 years; SD = 4.8) and 114 VA mothers (mean age = 41.5 years; SD = 5.4), 36% of KA and 51% of VA mothers reported children receiving free or reduced-price lunch at school. Mother's attitudes toward HPV and the vaccine (t [163] = 2.49, P = .014) and intention to vaccinate their children improved significantly (2 1 = 18.38, P < .001). The measure of mother's positive attitudes toward HPV and the vaccine was significantly associated with the higher vaccination intention (OR = 0.246, p < .001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, HPV communication with healthcare providers). Findings did not suggest that child's sex or ethnicity moderated association between attitudes and vaccination intention. This brief intervention using digital stories was feasible and showed preliminary effects on promoting KA and VA mothers' intention to vaccinate their children against HPV.

A Parent Version of the Motors of COVID-19 Vaccination Acceptance Scale for Assessing Parents' Motivation to Have Their Children Vaccinated.

Parents' motivation to vaccinate their children against coronavirus disease 2019 (COVID-19) plays a crucial role in the uptake of COVID-19 vaccines among children. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) is a valuable tool for assessing individuals' vaccination-related attitudes and the factors influencing their decision to be vaccinated against COVID-19. This study adapted the MoVac-COVID19S to create a parent version (P-MoVac-COVID19S) and examined the psychometric soundness of two P-MoVac-COVID19S versions (a 9-item version (P-MoVac-COVID19S-9) and a 12-item version (P-MoVac-COVID19S-12)) for assessing parents' motivation to vaccinate their children. A total of 550 parents completed the P-MoVac-COVID19S and a questionnaire assessing the factors that impact parents' intention to allow their children to receive the COVID-19 vaccine using a vaccine acceptance scale. We enquired about the level of parental worry regarding the adverse effects of COVID-19 vaccines on children's health and the number of COVID-19 vaccine doses received by parents. The factor structures of the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 were examined using confirmatory factor analysis. The internal consistency, test-retest reliability, and concurrent validity of the P-MoVac-COVID19S were also examined. The results revealed that the P-MoVac-COVID19S-12 has a four-factor structure, which aligns well with the theoretical framework of the cognitive model of empowerment; the P-MoVac-COVID19S-9 has a one-factor structure. Both the P-MoVac-COVID19S-9 and P-MoVac-COVID19S-12 had good internal consistency and test-retest reliability and acceptable concurrent validity. The results of this study demonstrated that the P-MoVac-COVID19S is a reliable and valid instrument for assessing parent's motivation to vaccinate their children against COVID-19.

Reaching late adopters: factors influencing COVID-19 vaccination of Marshallese and Hispanic adults

BackgroundMarshallese and Hispanic communities in the United States have been disproportionately affected by COVID-19. Identifying strategies to reach late vaccine adopters is critical for ongoing and future vaccination efforts. We utilized a community-engaged approach that leveraged an existing community-based participatory research collaborative of an academic healthcare organization and Marshallese and Hispanic faith-based organizations (FBO) to host vaccination events.MethodsBilingual Marshallese and Hispanic study staff conducted informal interviews with 55 participants during the 15-minute post-vaccination observation period and formal semi-structured interviews with Marshallese (n = 5) and Hispanic (n = 4) adults post-event to assess the implementation of community vaccine events at FBOs, with a focus on factors associated with the decision to attend and be vaccinated. Formal interview transcripts were analyzed using thematic template coding categorized with the socio-ecological model (SEM). Informal interview notes were coded via rapid content analysis and used for data triangulation.ResultsParticipants discussed similar factors influencing attitudes and behaviors toward receiving the COVID-19 vaccine. Themes included: (1) intrapersonal – myths and misconceptions, (2) interpersonal – protecting family and family decision-making, (3) community – trust of community location of events and influence of FBO members and leaders, (4) institutional – trust in a healthcare organization and bilingual staff, and (5) policy. Participants noted the advantages of vaccination delivery at FBOs, contributing to their decision to attend and get vaccinated.ConclusionsThe following strategies may improve vaccine-related attitudes and behaviors of Marshallese and Hispanic communities not only for the COVID-19 vaccine but also for other preventive vaccinations: 1) interpersonal-level – develop culturally-focused vaccine campaigns targeting the family units, 2) community-level – host vaccination events at convenient and/or trusted locations, such as FBOs, and engage community and/or FBO formal or lay leaders as vaccine ambassadors or champions, and 3) institutional-level – foster trust and a long-term relationship with the healthcare organization and provide bilingual staff at vaccination events. Future research would be beneficial to investigate the effects of replicating these strategies to support vaccine uptake among Marshallese and Hispanic communities.

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania.

Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania. Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children. All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8%) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95% confidence interval Tsh 2,523-3,610; 1 USD∼Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children. Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness. NCT03252288.

Assessing the longitudinal effects of the continuation and discontinuation of the school-located influenza vaccination programme on parental vaccine hesitancy in Hong Kong.

School-located influenza vaccination programme (SIVP) can effectively promote childhood seasonal influenza vaccination (SIV). However, the longitudinal effects of continuation and discontinuation of the SIVP on parents' vaccine hesitancy remained unknown. A two-wave longitudinal study recruited adult parents who had at least one child attending a kindergarten or primary school using random-digital-dialled telephone interviews. Generalized estimating equation and structural equation modelling were used to examine the impact of changes in schools' SIVP participation status on parents' vaccine-related attitudes, and childhood SIV acceptance over 2years in Hong Kong. Children's SIV uptake varied by the schools' SIVP participation status. The highest SIV uptake was found in schools that consistently participated in SIVP (Consistent participation group) (2018/2019: 85.0%; 2019/2020: 83.0%) but lowest in the Consistent non-Participation group (2018/2019: 45.0%; 2019/2020: 39.0%). SIV uptake increased in the Late Initiation group but declined in the Discontinuation group. An increasing trend of parental vaccine-hesitant attitudes was observed in the Consistent non-Participation group. Initiation and continuation of the SIVP can reduce parental vaccine hesitancy to achieve a high childhood SIV uptake. Conversely, discontinuation of the SIVP or persistent resistance to the implementation of SIVP can increase parental vaccine hesitancy and reduce childhood SIV uptake.

Surveillance Systems for Monitoring Vaccination Coverage with Vaccines Recommended for Pregnant Women, United States.

Pregnant women* and their infants are at increased risk for serious influenza, pertussis, and COVID-19-related complications, including preterm birth, low-birth weight, and maternal and fetal death. The advisory committee on immunization practices recommends pregnant women receive tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, and influenza and COVID-19 vaccines before or during pregnancy. Vaccination coverage estimates and factors associated with maternal vaccination are measured by various surveillance systems. The objective of this report is to provide a detailed overview of the following surveillance systems that can be used to assess coverage of vaccines recommended for pregnant women: Internet panel survey, National Health Interview Survey, National Immunization Survey-Adult COVID Module, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Vaccine Safety Datalink, and MarketScan. Influenza, Tdap, and COVID-19 vaccination coverage estimates vary by data source, and select estimates are presented. Each surveillance system differs in the population of pregnant women, time period, geographic area for which estimates can be obtained, how vaccination status is determined, and data collected regarding vaccine-related knowledge, attitudes, behaviors, and barriers. Thus, multiple systems are useful for a more complete understanding of maternal vaccination. Ongoing surveillance from the various systems to obtain vaccination coverage and information regarding disparities and barriers related to vaccination are needed to guide program and policy improvements.

Knowledge and practices of vaccination for children with rheumatic diseases: A single-center study in China

ABSTRACT Patients with pediatric rheumatic diseases (PRDs) have higher morbidity and mortality associated with infectious diseases. Vaccination is an effective way to prevent infection. This study aimed to understand the vaccination status, vaccination-related attitudes, and adverse reactions in patients with PRDs in one of the largest Pediatric Rheumatic and Immune centers in China. A cross-sectional study using an online questionnaire was conducted among the caregivers of patients with PRDs admitted to the Children’s Hospital of Chongqing Medical University. 189 valid questionnaires were collected. The most two common PRDs in this study were juvenile idiopathic arthritis (29.6%) and systemic lupus erythematosus (19.6%). Univariate analysis and multivariate logistic regression were used to identify potential factors associated with vaccination completion among these patients. Univariate analysis suggested that the age of onset, course of the disease, treatment duration, disease duration <1 month, disease duration ≥24 months, treatment duration <1 month, use of biological agents, at least one hospitalization, whether with one-time intravenous human immunoglobulin, caregiver concerns about vaccination before or after illness, and vaccine hesitancy may affect the scheduled vaccination completion by age in patients (p < .05). Multivariate logistic regression analysis showed that the age of onset (OR, 1.013; 95% CI, 1.005–1.022; p = .002) and caregiver concerns about vaccination before illness (OR, 0.600; 95% CI, 0.428–0.840; p = .003) independently influenced patients’ completion of scheduled vaccinations. This study suggests that rheumatic disease and treatment may influence age-appropriate vaccination. Appropriate education for patients and carers may improve vaccination cognition and attitudes.

PARENTS COMMITMENT TO THE CHILDS VACCINATION ACCORDING TO AGE SCHEDULE: A SYSTEMATIC REVIEW

Vaccine uptake may be predicted in large part by whether or not vaccinations are accepted. This has ramifications for public health since unvaccinated people are more likely to get illnesses that vaccines can prevent. Our purpose in conducting this systematic literature review was to analyse parents commitment to the childs vaccination schedule.We conducted a comprehensive literature search for studies published between January 2012 and present that used instruments to gauge vaccine-related attitudes and convictions. Included studies surveyed parents quantitatively to determine their opinions on paediatric immunizations. We compiled the data with an emphasis on how well the various methods of measuring hesitation performed. A total of 16 studies were included because they satisfied the inclusion criteria 13 of these used a cross-sectional research design, 2 used a case-control study design, 1 used a pre-post study design. There was a wide variance in study sample sizes from 49 to 12,259. The PACV Survey of Parents Opinions on Childrens Vaccines was the instrument most often used. The Health Belief Model was the most popular theoretical framework. There was a broad range of questions designed to elicit opinions on vaccinations.The studies that polled parents about their thoughts on immunization utilized a wide variety of questionnaires. Validated and standardized but adaptable tools might enhance methods for measuring parents perspectives on immunization. It is recommended that researchers in this field use a standardized set of questions.

Parental Seasonal Influenza Vaccine Hesitancy and Associated Factors in Shanghai, China, during the COVID-19 Pandemic: A Cross-Sectional Study.

Seasonal influenza may overlap with the COVID-19 pandemic, and children are one of the priority populations for influenza vaccination in China, yet vaccine coverage has been low. This study aimed to investigate the extent of parental influenza vaccine hesitancy (IVH) and to explore the associated factors. The study was conducted in Shanghai, China, from 1 June 2022 to 31 July 2022, using an anonymous questionnaire to survey a random sample of parents of children aged six months to 14 years. Binary logistic regression models were used to identify factors associated with IVH. Of the 5016 parents, 34.05% had IVH. Multivariate analysis showed that after adjustment for non-modifiable markers (i.e., sociodemographic, health status, and past vaccination status), being affected by negative influenza vaccine news and having higher "complacency" were positively associated with parental IVH. Higher knowledge of influenza vaccination, being recommended by healthcare workers (HCWs), people around having a positive attitude toward influenza vaccine and having higher levels of "confidence" and "convenience" were negatively associated with parental IVH. In China, public health education aimed at modifying vaccination-related attitudes and beliefs, as well as knowledge and societal influences, could help reduce influenza vaccination hesitancy.