Vaccine Hesitancy Research Articles

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

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

Children and adolescents’ experiences of mandatory SARS-CoV-2 testing in schools: a cross-sectional survey

BackgroundPublic health measures during the COVID-19 pandemic had dramatic consequences for children and adolescents. However, policy-makers and healthcare researchers did not give sufficient weight to children’s perspectives. One common public...

Overview of CHIC symposia series: Summary of Africa and South Asia symposia

This article presents an overview of the main challenges and lessons learned that were presented during the symposia organized by the Coalition to Strengthen the HPV Immunization Community (CHIC) in Africa and South Asia in 2022. Discussions at these meetings revolved around introduction, planning, implementation, and sustainability of HPV prevention and control programmes, with a particular focus in HPV immunisation, as well as cervical cancer screening in South Asian countries. This article also discusses the recently endorsed off-label single-dose HPV vaccination schedule and its potential impact on programme delivery and access. Furthermore, it highlights the importance of intersectional collaboration, effective communication and advocacy strategies, and the need for robust health information systems. Some of the critical factors identified for reducing the burden of cervical cancer in low- and middle-income countries (LMICs) included strategies for increasing access and coverage, addressing vaccine hesitancy, and building capacity among health care providers. The symposia emphasized the importance of face-to-face interactions for collaboration and decision making, with live translation services enabling full participation by stakeholders from diverse backgrounds. The paper concludes with a call for continued collaboration to make progress in reducing the burden of cervical cancer in LMICs.

Effective communication by health care workers to promote HPV vaccination: Lessons learned from Kenya, India, and Nigeria

Health care workers play an essential role in maintaining the public trust in vaccination programmes globally, and more specifically, in low- and middle-income countries. This role is particularly important in building trust in the human papillomavirus (HPV) vaccine. While there are many factors that affect HPV vaccine acceptance, health care workers are one of the most critical influences in the decision-making process among parents as well as adolescent girls. In this paper, we sought to better understand how health care workers in a diverse set of countries communicate and promote HPV vaccines. We summarize communication approaches and lessons learned by health care workers in Kenya, India, and Nigeria through a case study approach. In Kenya, the utilization of a multisectoral approach proved to be very important. In India, intense social mobilization with targeted messaging by target audience laid the groundwork for community acceptance. An evolving communication strategy was essential in Nigeria, where there is no national HPV vaccination programme. Given the increase in vaccine hesitancy globally, the lessons learned through these three country examples highlight the importance of communication efforts in increasing vaccine acceptance.

Exploring vaccine hesitancy in digital public discourse: From tribal polarization to socio-economic disparities.

This study analyzed online public discourse on Twitter (later rebranded as X) during the COVID-19 pandemic to understand key factors associated with vaccine hesitancy by employing deep-learning techniques. Text classification analysis reveals a significant association between attitudes toward vaccination and the unique socio-economic characteristics of US states, such as education, race, income or voting behavior. However, our results indicate that attributing vaccine hesitancy solely to a single social factor is not appropriate. Furthermore, the topic modeling of online discourse identifies two distinct sets of justifications for vaccine hesitancy. The first set pertains to political concerns, including constitutional rights and conspiracy theories. The second pertains to medical concerns about vaccine safety and efficacy. However, vaccine-hesitant social media users pragmatically use broad categories of justification for their beliefs. This behavior may suggest that vaccine hesitancy is influenced by political beliefs, unconscious emotions, and gut-level instinct. Our findings have further implications for the critical role of trust in public institutions in shaping attitudes toward vaccination and the need for tailored communication strategies to restore faith in marginalized communities.

COVID-19 Parental Vaccine Hesitancy: The Role of Trust in Science and Conspiracy Beliefs

Background. Parent vaccine hesitancy is a sensitive topic despite the benefits associated with children’s vaccination. Especially regarding the COVID-19 vaccination, parents displayed concerns about children’s vaccination, questioning their effectiveness and security. Although several studies were conducted on the general population, few studies investigated this relationship on parents’ intentions. Methods. An online survey was advertised from May to December 2022 on social networks, collecting data from 109 participants (90% F; mean age: 41.34 years, SD: ±6.40). The survey assessed sociodemographic characteristics, vaccine hesitancy through the Parents Attitude towards Childhood Vaccine—PAVC, trust in science through the Belief in Science Scale—BISS, and conspiracy beliefs through the Generic Conspiracist Beliefs Scale—GCBS. Results. In our sample, 29 parents (26.6%) scored more than 50 points to PAVC and, for this reason, were considered hesitant. Moreover, more than half of parents (60.6%) declared that they did not intend to vaccinate their children in the future. The path analysis model showed that parents with low education tended to have higher conspiracy beliefs (β = −0.40). Holding conspiracy beliefs (β = 0.28) and having low trust in science (β = −0.23) was associated with higher parent hesitancy and, in turn, no future intention to vaccinate their children for COVID-19 (OR = 0.83, p < 0.001). Conclusion. The results of the current paper suggest that targeted campaigns should be aimed at parents with lower levels of education, mainly on social media, debunking the most common fake news or myths, independently from the type of vaccine, and highlighting the importance of scientific research for improving people’s living conditions.

Political and Community Logics of Emergent Disease Vaccine Deployment: Anthropological Insights from DRC, Uganda and Tanzania

With a growing number of emerging infectious diseases and the rapid development of vaccines during epidemics and pandemics, public health officials at the global and national level have reported concerns about vaccine hesitancy, often attributing this to a problem of misinformation and poor understanding of risk. However, social scientists have found that vaccination perceptions are complex and multi-faceted. By focusing on the historical, cultural and political influences that affect vaccine acceptance, as well as social justice questions that examine the fair distribution of vaccines, we explore the political and community logics of vaccine deployment using a case study approach. We found differing logics depending on the vaccine and the context and argue that political and community logics come to the forefront during outbreaks as vaccine strategies often are imposed—in different ways—by the Global North. We suggest that, prior to the development and deployment of new vaccines for emergent diseases in the Global South, political level and community logics must be acknowledged and engaged with.

Predictors for vaccine hesitancy among nursing students in Namibia

Background: Healthcare workers (HCWs) are a priority group targeted for vaccination because they are greatly exposed to infectious agents.Aim: To determine the prevalence of coronavirus disease 2019 (COVID-19) vaccination and associated risk factors for vaccine hesitancy to recommend vaccine uptake strategies among student nurses.Setting: The study was carried out at the University of Namibia, main campus in Windhoek.Methods: A cross-sectional study was undertaken using a proportionate stratified sampling method. The total sample for the study was 509 students. Statistical Package for the Social Sciences (SPSS) 29 was used to analyse data. Frequencies and proportions were calculated. Bivariate analysis and multiple logistic regression were conducted to pronounce the predictors for vaccine hesitancy.Results: Only 31.40% students were vaccinated against COVID-19. Out of the vaccinated, 41.80% (p 0.001) were previously infected with COVID-19. Participants who were not HCWs before nursing school were most likely not to be vaccinated (p 0.001). Most unvaccinated students were hesitant because of a lack of information about the COVID-19 vaccine’s side effects (50.36%) and not knowing its effectiveness (38.13%). A total 60.80% of the participants believed a vaccine was needed to overcome the pandemic.Conclusion: We recommend the creation of targeted awareness campaigns that shed more light on the benefits of vaccination and vaccine side effects.Contribution: The study identifies key factors that can be targeted to change student nurses’ behaviour towards vaccination and offers valuable data that can inform preparedness and response strategies for future pandemics in Namibia and similar regions.

Association Between Medical Debt and Vaccine Uptake in the USA, 2021-2022.

Many individuals do not receive recommended vaccines, increasing infectious disease morbidity and mortality. It is unknown whether the financial practices of US healthcare institutions contribute to vaccine hesitancy. To determine whether medical debt is associated with low vaccine uptake. Cross-sectional analysis of the association between medical debt and vaccine receipt. 56,373 adult participants in the 2021-2022 National Health Interview Survey. Presence of medical debt at the time of survey administration. We used logistic regression models to assess whether medical debt was associated with recent vaccine receipt, adjusting for sociodemographic, health, and access-to-care variables. We performed a sensitivity analysis restricted to individuals with health insurance and conducted a falsification test of the hypothesis that current medical debt would not be associated with remote prior vaccination (i.e., > 1year prior, likely before debt acquisition). Individuals with medical debt were less likely than those without such debt to receive any recent vaccine (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.76-0.91), including influenza vaccination (aOR 0.83, 95% CI 0.75-0.91) or COVID-19 vaccination (aOR 0.79, 95% CI 0.69-0.91). Analyses limited to insured individuals had similar findings (aOR for any recent vaccination 0.79, 95% CI 0.72-0.88). In the falsification test, current medical debt was not associated with remote prior vaccination (aOR 1.04, 95% CI 0.93-1.16). Current medical debt is associated with lower likelihood of recent vaccine receipt in both insured and uninsured individuals. Policies that minimize medical debt may improve vaccine coverage.

Assessment of childhood vaccination hesitancy among syrian parents under temporary protection

Background and AimVaccination programs become increasingly crucial during migratory movements driven by conflict and other disruptions. This study aims to determine the prevalence of childhood vaccination hesitancy among Syrian parents under temporary protection and identify areas for targeted interventions.MethodA total of 227 Syrian parents attending three Immigrant Health Centers in Sultangazi were assessed using the Arabic version of the Parent Attitude about Childhood Vaccines (PACV) survey, conducted between October and December 2023.ResultsThe prevalence of vaccine hesitancy among these parents was found to be 10.6%. An inverse correlation was observed between maternal education level and vaccine hesitancy, indicating that higher education levels were associated with lower levels of hesitancy.ConclusionThe observed rate of vaccine hesitancy among Syrian parents under temporary protection underscores the urgent need for targeted interventions. Tailored vaccination strategies for immigrant populations are essential to improve immunization rates and ensure the health and well-being of these communities.

Behaviorally Informed Text Message Nudges to Schedule COVID-19 Vaccinations: A Randomized Controlled Trial.

Vaccine hesitancy, especially related to COVID-19 vaccinations among Veterans, may limit uptake. Behaviorally informed text-based messages have the potential to improve uptake of COVID-19 vaccinations. To evaluate the impact of two different behaviorally informed text message nudges on COVID-19 vaccine scheduling and completion, compared to standard control message. Prospective, three-arm patient-level randomized quality improvement trial. Between March and May 2021, 20,523 Veterans were eligible for the initial series of COVID-19 vaccination, enrolled at two large Veterans Health Administration sites. Arm 1 (Control): standard scheduling message; Arm 2 (Social Good): standard message plus behaviorally informed text message "When you get a vaccine now, you help protect yourself, your family, and your community"; and Arm 3 (Scarcity): standard plus behaviorally informed text message "Only a limited number of vaccine appointments are available." Outcomes were vaccine scheduling and/or completion rate within 7 days of receipt of text message (primary), and within 14 days and 30 days after receipt of text message (secondary). Veterans had an overall rate of 19% of scheduling or receiving a vaccination in 7 days. In our adjusted intention-to-treat analysis, we found no difference between intervention social good or scarcity (aOR 0.98, 95% CI, 0.88-1.09, for both arms) compared to standard scheduling message. We found no statistical differences in our secondary outcomes. During the initial phases of vaccine roll-out, two behaviorally informed text messages did not increase COVID-19 vaccination rates among Veterans compared to a standard scheduling message.

A study of some psychological variables as predictors of COVID-19 vaccination anxiety among Faculty Members of Ain Shams University

The study aimed to investigate the relative contribution of each of psychasthenia, psychological flexibility, suggestibility, and conspiracy beliefs in predicting the anxiety of vaccination with the anti COVID-19 vaccine among faculty members at Ain Shams University (ASU). Examining the difference in the sample’s scores on the vaccination anxiety scale and its sub-factors according to the variables (age—chronic diseases—academic specialization—previous infection with COVID-19—gender), the sample of the study included 139 faculty members at Ain Shams University aged ranged from 23 to 78 years, with a mean of 49.52 years, and a standard deviation of 13.29 years. The vaccination anxiety scale, psychasthenia scale, psychological flexibility scale, suggestibility scale, and conspiracy beliefs scale were used to collect data. The results revealed that the variables of suggestibility and conspiracy beliefs significantly contribute to predicting the vaccination anxiety among faculty members at Ain Shams University. There is a significant difference in the average scores on the vaccination anxiety scale according to age, with the difference in favor of the age group less than fifty years, as well as according to the presence/absence of a previous infection with COVID-19, with the vaccination anxiety being higher for those who were previously infected. There has been no observed significant difference according to the presence/absence of chronic diseases or academic specialization.

COVID-19 vaccine or booster uptake and hesitancy for children aged 6 months–5 years in the United States: A national descriptive study using the household pulse survey between March and May 2023

The Centers for Disease Control and Prevention recommends that children aged 6 months–5 years (children under 5) receive multiple doses of COVID-19 vaccine, including updated (bivalent) COVID-19 vaccine. However, since the updated vaccines became available for children under 5, there has been limited knowledge regarding hesitancy toward the original vaccine or boosters in vaccinating children. To address this gap, this study utilized data from the Household Pulse Survey conducted from March 1, 2023 to May 8, 2023 (Phase 3.8). The purpose of the study was to examine the proportion of children under 5 who had received at least one dose of COVID-19 vaccine and to assess the likelihood of vaccination, categorized as willingness to vaccinate, moderate hesitancy, and strong hesitancy. Additionally, we identified sociodemographic factors that may influence the level of vaccine hesitancy for children. Overall, 24.5 % (95 % CI: 22.2–26.8) of children under 5 had received at least one dose of the COVID-19 vaccine, with the highest percentage among non-Hispanic Asians (42.1 %, 95 % CI: 36.4–47.8). Respondents who had not received the vaccine showed a statistically significant decrease in their inclination to vaccinate children. There was a higher level of vaccine hesitancy among females compared to males regarding vaccinating children under 5. As household income and educational attainment decreased, there was an observed increase in the proportion of individuals showing strong vaccine hesitancy. Households without health insurance had significantly lower vaccine uptake and higher rates of strong vaccine hesitancy compared to those with health insurance. Parents, guardians, and healthcare providers play essential roles in vaccinating children under 5. Targeted interventions are needed to address vaccine hesitancy and promote the importance of booster doses in the vaccination of children.

Evaluating vaccination timing, hesitancy and effectiveness to prevent future outbreaks: insights from COVID-19 modelling and transmission dynamics.

The COVID-19 vaccine has been available in India since January 2021, although many individuals have refused to take the vaccine for various reasons. Vaccination plays a crucial role in disease control by preventing a substantial number of cases and associated disabilities. However, vaccine hesitancy poses a barrier that hinders these efforts. Our article presents a novel approach by proposing a mathematical model for COVID-19 that incorporates vaccine hesitancy, vaccine efficacy and behaviour compensation post-vaccination. The model is calibrated with COVID-19 incidence data for India from 13 February 2021 to 12 January 2022, using the Markov chain Monte Carlo method. The analysis examines the effects of hesitancy and social interventions through a series of practical simulations. The simulation results show that while COVID-19-infected individuals may have natural immunity, vaccination post-recovery is crucial to reduce cases by up to 64.1%. Social interventions, such as face masks and distancing, remain essential to prevent a rise in cases and ensure effective disease control. The model demonstrates that vaccination, combined with continued social interventions, is crucial for effectively reducing COVID-19 cases and preventing future outbreaks. Addressing vaccine hesitancy and maintaining preventive measures are key to successfully controlling the pandemic.

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

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

Respiratory Vaccination Rates in People Living With Spinal Cord Injury/Disorder in Switzerland: A Descriptive Analysis of Coverage and Vaccine Hesitancy.

The aim of the study is to provide a population-based evaluation of vaccination coverage to prevent respiratory complications from SARS-COV-2, influenza, and pneumococcus, among community-dwelling persons with spinal cord injury/disease. This is a cross-sectional survey conducted in 2022, utilizing questionnaires administered to persons with spinal cord injury/disease living in Switzerland. Main outcomes were ever-vaccination rates for SARS-COV-2, influenza, and pneumococcus. Secondary outcomes included demographics, lesion and education levels, as well as respiratory and cardiovascular conditions. Vaccine hesitancy was additionally assessed for all three vaccines in nonvaccinated persons through questions on reasons for not getting vaccinated. A total of 1158 persons participated in this survey. Overall vaccination rates were highest for SARS-COV-2 86.5% (95% CI = 84.4-88.3), followed by influenza 44.6 (41.7-47.6) and pneumococcus: 7.5% (6.0-9.3). The most prominent reasons for not being vaccinated were doubt on effectiveness (72.7%) and potential side effects (60%) for SARS-COV-2, patients did not feel at risk for influenza (57%) and insufficient information from the physician (52.4%) for pneumococcus vaccination. In individuals with spinal cord injury/disease, vaccination coverage is notably low for influenza and especially pneumococcus. Vaccine hesitancy varies between vaccination types and is associated with vaccine-specific reasons. These findings underscore the imperative for updated clinical vaccination guidelines, improved public health information, and targeted intervention programs for specific patient groups.

Interventions involving nudge theory for COVID-19 vaccination: A systematic review and meta-analysis.

New approaches to mitigate vaccine hesitancy and improve vaccine uptake are urgently needed. Nudging has shown effective results in several health areas. However, the effectiveness of interventions involving nudge theory in increasing COVID-19 vaccination remains unclear. We searched PubMed, Web of Science, and Scopus for randomized controlled trials published before December 31, 2022, to determine whether interventions involving nudge theory improved COVID-19 vaccination behavior and intent. Risk ratio (RR) and a 95% confidence interval (CI) were used as pooled measures to assess vaccination behavior. Intention to vaccinate was reported in a narrative synthesis. Sixteen randomized controlled trials involving 176,125 participants were included. Interventions involving nudge theory weakly boosted the COVID-19 vaccine uptake rate (RR = 1.21, 95% CI [1.07, 1.36], p < .01). Subgroup analysis showed a weak positive effect of social norms (RR = 2.04, 95% CI [1.61, 2.57]), defaults (RR = 1.32, 95% CI [1.03, 1.69]), and salient reminders (RR = 1.19, 95% CI [1.04, 1.36]). Nudge interventions integrating multiple components were more efficacious in increasing vaccination rates compared to nudge alone. The effect of nudging interventions weakened over time (p < .001). Most studies (10 of 11) involving vaccination intention outcomes showed positive or partially positive results. Interventions involving nudge theory can promote COVID-19 vaccination behavior and intentions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

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

Vaccine hesitancy: a structured review from a behavioral perspective (2015–2022)

ABSTRACT Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

The Relationship Between Fear Of Injection, Vaccine Attitude, and Vaccine Hesitance: A Study On The Turkish Vaccine "Turkovac"

This study aims to examine the relationship between blood-injection-injury phobia, attitudes towards COVID-19 Turkovac vaccine and hesitation regarding Turkovac vaccine. The study is a cross-sectional study conducted in the population. The research population consists of patients who applied to a family medicine clinic in the city center of Sakarya and their family members over the age of 18. The research data was collected from 574 participants through a face-to-face survey technique. IBM SPSS and AMOS programmes were used to analyse the data. The conclusions of the showed that the majority of participants had a low fear of injections and their attitudes and hesitancy towards the Turkovac vaccine was partially high. Furthermore, the empirical results of the study indicated that there was a strong positive correlation between attitudes towards Turkovac and hesitancy towards Turkovac vaccine, and a low negative correlation between injection fear and attitudes and hesitancy towards Turcovac vaccine.