Vaccine Refusal Research Articles

Caregivers’ hesitancy and outright refusal toward children’s COVID-19 vaccination in the Democratic Republic of Congo: A community-based cross-sectional study

ABSTRACT Data from the global South show higher COVID-19-related mortality in children compared to the North. Parents’ willingness to vaccinate their children once COVID-19 vaccines are available is poorly documented. We assessed parents’ willingness to vaccinate their children in the DRC. A year after the vaccination program started, we conducted a population and online-based cross-sectional study, using the WHO modified Behavior and Social Drivers questionnaire among parents and caregivers in the eastern DRC. We performed Modified Poisson regressions to determine factors associated with vaccine hesitancy and outright refusal, focusing on the intention to vaccinate one’s children as our primary outcome. Of the 1709 respondents aged 38 years, 82.56% were unwilling to vaccinate their children, of which 26.80% were hesitant and 55.76% were outright refusals. Drivers of hesitancy were religious refusal of vaccine, non-healthcare status, and caregiver beliefs about vaccine unsafety. Independent predictors of refusal were religious refusal of vaccine, neither healthcare nor student status and belief about vaccine effectiveness, unsafety, and distrust. In addition, both hesitancy and refusal to vaccinate one’s children were driven by not being ready to get vaccinated if recommended or mandated. In contrast, parents’ and caregivers’ trust in the government and readiness to vaccinate themselves reduced hesitancy and outright refusal to vaccinate one’s children, respectively. Briefly, COVID-19 vaccine hesitancy and outright refusal in eastern DRC are influenced by individual (subjective convictions) and system-level factors (government confidence, mandate trust). It is important to address these issues to improve vaccine coverage during disease outbreaks and mitigate public health risks.

ATTITUDES AND AWARENESS OF THE POPULATION OF CENTRAL AND WESTERN REGIONS OF UKRAINE TOWARDS VACCINATION

In the modern world, vaccination is the most eff ective and evidence- based method of preventing the onset and severity of infectious diseases. Today, the WHO has identifi ed vaccine hesitancy as a global public health threat [25]. The social and cultural background of people infl uences their perception of vaccines, which prompted us to investigate this problem. Aim. To study the infl uence of sociodemographic factors on vaccination attitudes of children and adults in the central and western regions of Ukraine.Materials and methods. A cross- sectional study was conducted, which included a survey of the population of diff erent social status. The study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the bioethics committee. We also analyzed literature data from PubMed, Medscape and CSC. The work was performed within the framework of the research project 0122U000039 «Improvement of methods of diagnosis, treatment and rehabilitation of the most common diseases of childhood». No confl icts of interest exist.Research results and discussion. 1000 respondents were interviewed by questionnaire from Kyiv, Cherkasy, Kirovograd, Khmelnytsky, Zhytomyr, Chernivtsi, Ternopil, Rivne, Volyn, Ivano- Frankivsk, Lviv regions. The data obtained indicate that barriers to vaccination are caused by low awareness of vaccination, excessive negative infl uence of opinion leaders, prevalence of myths and falsifi cations about vaccination, lack of health care resources and low supply of recommended vaccines, and forced migration. Low awareness and low vaccination coverage are also associated with low awareness among health workers who do not work directly with vaccines, falsifi cation of vaccination data, and the presence of anti-vaccine health workers. The negative attitude of parents towards vaccination is also very important, as it aff ects their children.Conclusions.1. Fear of side eff ects, long-term complications, and doubts about the quality of vaccines have been identifi ed as factors in vaccine refusal.2. The most common groups of vaccine refusers are the elderly (53.3 %) and men (16.8 %).3. The high cost of vaccines that are not included in the list of mandatory vaccines is one of the reasons for the decrease in vaccination rates.4. Improved communication between the doctor and the patient is one of the factors increasing the vaccination rate among the population.5. Information about the availability of vaccines and places of vaccination, peculiarities of the post-vaccination period and information about the possible consequences of ignoring vaccination should be provided in the media (television, radio), especially among the elderly.

Effects of metaphorical communication on vaccine confidence in the adolescent population

Abstract Vaccine hesitancy, defined as delay or refusal of vaccination despite the availability of vaccination services, has been included by WHO among the top 10 global health threats. Individual decision-making process can be strongly affected by communication. The use of metaphors is common in public health communication and increased during the COVID19 pandemic. Although some evidence has supported the persuasive potential of metaphorical language over scientific language, further research is needed. Our study aimed at comparing the effects of neutral scientific talk with war and protective metaphors on health communication. An online survey was conducted on a convenience sample of Italian teenagers randomly allocated to three study arms. Each participant was invited to watch a specific version of an informative video on infections and vaccines (group 1: neutral-scientific approach, group 2: metaphorical-war, and group 3: metaphorical-protective approach). After watching the video, each participant responded to an ad-hoc questionnaire. A total of 2681 subjects were randomly allocated to the three groups. No significant differences regarding age, sex and geographical area were detected between groups. Median age of the sample was 17 years (mean 16,8) and 56.8% were girls. The general attitude towards vaccination in group 2 and 3 was largely positive, with the majority agreeing (strongly or tend to agree) on the fact that vaccination is important (group 2: 89%; group 3: 92%), safe (group 2: 91%; group 3: 92,5%), effective (group 2: 85%; group 3: 88%), and does not generate anxiety (group 2: 80%; group 3: 83%). Higher level of distrust against vaccines was found in group 1, where 32% of participating adolescents are strongly or tend to be anxious about getting vaccinated. The results of our survey suggest that emotional involvement evoked through the use of metaphorical language may have, at least in the short run, some positive effect on vaccine confidence. Key messages • Use of metaphors can be successfully used in public health communication. • Messages evoking either war or protecting concepts are more efficacious than plain scientific language.

Empowering Educators: Italian Nurses’ Knowledge, Attitudes, Practices, and Vaccine Hesitancy

Abstract Background Vaccine hesitancy (VH) among healthcare workers is a prevalent global phenomenon and a public health concern. The study aims were i) identifying knowledge, attitudes, and practices (KAP); ii) estimating the prevalence of VH regarding recommended vaccines for healthcare workers (HWs). Methods Multicenter cross-sectional study of an Italian sample of nurses and nursing students. Following a systematic review (PROSPERO ID:CRD42020212252), a validated questionnaire was used (Cronbach’s alpha=0.82). Two multivariable logistic regression model were built to identify predictors of (1) VH to the recommended vaccine for HWs; (2) acceptance of the fourth COVID-19 vaccine dose. Results 226 participants were enrolled (169 nurses; 57 students). Regarding KAP: only four nurses (1.8%) had adequate knowledge among vaccine recommended for HWs, whereas 30% (N = 66) reported never having recommended vaccinations during clinical practice. 106 (46%) nurses/students reported VH for at least one of the vaccines recommended for HWs - high levels of VH were recorded for influenza vaccination (N = 88,38.9%) and fourth COVID-19 vaccine dose (N = 100,44.3%). At the multivariable analysis, (1) significant associations with highest levels of VH were found for nurses who reported having at least one child (OR:5.42, 95%CI: 1.64-17.89) and who had not received any dose of influenza vaccination in the last 5 years (OR:13.25, 95%CI: 5.29-33.16). Lowest odds of VH was found for nurses employed in Primary Health Care (OR:0.17, 95%CI: 0.03-0.98); (2) routinely recommending vaccinations during practice (OR:0.38, 95% CI: 0.15-0.95) was associated with acceptance of fourth COVID-19 vaccine dose. Conversely, reliance on social media as the primary information source seemed to be a predictor of COVID-19 vaccine refusal (OR:2.05 95% CI: 1.31-3.20). Conclusions Preliminary results identified predictors of VH among nurses, offering insights for organizations to effectively tailor public health interventions. Key messages • High levels of vaccine hesitancy among nurses towards recommended vaccines for healthcare workers pose a threat to patient safety. • Empowering ‘educators’ through focused public health interventions is essential to address factors contributing to vaccine hesitancy among healthcare workers.

Assessing vaccine hesitancy and vaccine literacy in the European prison population: a multicenter repeated cross-sectional study

Abstract The study aimed to quantify vaccine hesitancy and vaccine literacy in prison populations and assess their correlation prior and after the implementation of training and information activities targeting PLP. A repeated cross-sectional observational study was conducted in 13 prisons of 4 European countries prior and after the implementation of a co-developed training package. The study sample included 847 people living in prison in the baseline round. The second round is currently ongoing. Through a structured questionnaire vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal history and socio-demographic characteristics of participants were assessed. Exploratory factor analysis was used to extract three independent components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; multiple linear regression was applied to assess the association between vaccine hesitancy and vaccine literacy and general health literacy. All analyses were adjusted for socio-demographic variables. In the baseline round, we identified three independent components of vaccine hesitancy explaining 49% of the total variance: Mistrust (proportion of the variance explained, 27%), Concern (14%) and Conspiracy (8%). All the components were associated with previous vaccine refusal (p-value <0.001) and presented very good internal consistency. Young participants presented the highest levels of vaccine hesitancy; migrants had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of academic education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were associated with general health literacy (all p-values <0.001).

Dynamic factors associated with COVID-19 vaccine uptake in Cameroon between 2021 and 2022.

Little is known about attitudes towards COVID-19 vaccination in sub-Saharan Africa, where immunisation coverage is the lowest in the world. The study aimed to identify factors associated with COVID-19 vaccine hesitancy and uptake in Cameroon, and assess changes in these factors over a period of time. The study was conducted in the ten regions of Cameroon. The authors conducted a two-phase cross-sectional survey in the 10 regions of Cameroon, from July 2021 to August 2021 (Phase one) and from August 2022 to September 2022 (Phase two). We analysed reasons for vaccine hesitancy descriptively and used logistic regression to assess factors associated with hesitancy. Overall, we enrolled 12 109 participants: 6567 (54.23%) in Phase one and 5542 (45.77%) in Phase two. Of these, 8009 (66.14%) were not interested in receiving the COVID-19 vaccine (n = 4176 in Phase one, n = 3833 in Phase two). The refusal rate increased significantly in the northern region from 27.00% in Phase 1 to 60.00% in Phase two. The leading contributor to COVID-19 vaccine hesitancy was fear that the vaccine was dangerous, which was significantly associated (95% confidence interval [CI], p < 0.05%) with vaccine refusal in both phases. Overall, 32.90% of participants (n = 2578) perceived the COVID-19 vaccine to be dangerous. Advanced age, male gender, Muslim religion and low level of education were associated with vaccine acceptance. Participants reported that healthcare workers were the most trusted source of information about the COVID-19 vaccine by 5005 (42.84%) participants. Despite the investment of the Ministry of Health and its partners in community engagement, focussing on communication about the vaccine efficacy, tolerance and potential adverse events, fear of the vaccine remains high, likely leading to vaccine hesitancy in Cameroon between 2021 and 2022. The study highlight regional variations in COVID-19 vaccine acceptance in Cameroon, with factors age, gender, religion and education influencing willingness to vaccine. Trust in health workers was high, indicating that, tailored, community-led vaccination strategies are key for improving vaccine uptake, not only for COVID-19 but also for future epidemics.

Understanding Factors Responsible for Delay and Non-Compliance in COVID-19 Vaccination at a Tertiary Care Hospital in Mumbai, India

Background: Despite extensive first-dose coverage, delays in second doses and late first doses prompted a study on vaccine hesitancy and non-compliance. Methods: In 2022, a cross-sectional survey was conducted at a Mumbai vaccination center, involving 504 individuals who had received either the first or second dose of the COVID-19 vaccine. The study, conducted from February to April 2022, included interviews using a pre-validated schedule to assess vaccine acceptance, refusal, socio-demographics, and reasons for hesitancy. Data analysis was performed using IBM SPSS Statistics software 23.0 to understand factors influencing vaccine delay and non-compliance. Result: The study interviewed 504 participants at a Mumbai vaccination center. Most were male (63.9%), aged 18-44 (80%), and skilled workers (22.6%). Of those surveyed, 64 had received only the first vaccine dose. The delay in receiving the second dose was 37.4% for BBV152 and 41% for ChAdOx1 nCoV-19. The primary reason for delay was lack of time (50.6%), followed by fear of the vaccine (14.8%). Reasons for getting vaccinated later included resolving constraints (40.5%) and compulsion (25.8%). Vaccine choice reasons varied significantly (p &lt; 0.0005), but delay proportions were similar across vaccines (p = 0.531). Conclusion: Even after many efforts by the government, large numbers of people have not taken vaccine on time. One of the reasons, as seen in the study is a busy work schedule which has hindered timely vaccination in individuals. Making vaccine available at work place may address this issue to some extent, besides ownership of the program by the public.

Institutional trust, conspiracy beliefs and Covid-19 vaccine uptake and hesitancy among adults in Ghana.

Vaccine hesitancy is considered one of the ten threats to global health. In the context of the COVID-19 pandemic, vaccine hesitancy may undermine efforts toward controlling or preventing the disease. Nevertheless, limited research has examined vaccine hesitance, particularly in low- and middle-income countries (LMICs). It is thus imperative to examine how institutional trust and conspiracy belief in tandem influence the uptake of COVID-19 vaccines. Using data (n = 2059) from a cross-sectional study in Ghana, this study examines the association between institutional trust, conspiracy beliefs, and vaccine uptake among adults in Ghana using logistics regression. The regression model (model 3) adjusted for variables such as marital status, age, gender, employment, income, and political affiliations. The results show that individuals were significantly less likely to be vaccinated if they did not trust institutions (OR = .421, CI = .232-.531). Similarly, we found that individuals who believed in conspiracy theories surrounding the COVID-19 vaccine were less likely to be vaccinated (OR = .734, CI = .436-.867). We also found that not having a COVID-19-related symptom is associated with vaccine refusal (OR = .069, CI = .008-.618). Similarly, compared to those with a vaccine history, those without a vaccine history are less likely to accept the COVID-19 vaccine (OR = .286, CI = .108-.756). In conclusion, our results demonstrate the need for enhanced education to tackle conspiracy beliefs about the disease and enhance vaccine uptake. Given the role of trust in effecting attitudinal change, building trust and credibility among the institutions responsible for vaccinations ought to be prioritized.

Challenging Vavřička: Questioning Compatibility of the Mandatory Tetanus Vaccination with ECHR.

The compatibility of mandatory vaccinations with human rights has become a very current issue with the COVID-19 pandemic and the Vavřicka ruling by the European Court of Human Rights. This ruling has faced criticism for not conducting examinations related to disease and vaccines based on direct scientific evidence. In this analysis, an assessment will be made based on direct scientific evidence about tetanus and its vaccine. The prevailing reason for mandatory tetanus vaccination is to protect the health of the vaccinated individual. Competent adults have the right to refuse treatment. This rule also applies to preventive medical interventions, including tetanus vaccination. As a rule, parents are entitled to give consent for medical interventions on their children. If an immediate and serious threat permanently endangers the minor’s life, medical intervention can be carried out against the parents’ will. The limitation of parental autonomy is more disputed when the minor’s life is not immediately threatened. With respect to tetanus vaccination as a preventive medical intervention, it does not eliminate an immediate and serious risk of harm. As a result, interference with the parent’s discretion on tetanus vaccination as a preventive medical intervention should be evaluated for its compatibility with the current legal approach to medical interventions on minors and patient rights. Keywords: best interest, mandatory vaccination, preventive medical intervention, right to reject a medical intervention, vaccine refusal, tetanus Acknowledgments: Z.T. wrote Part II: Information on Tetanus, M.S.P. wrote the rest of the paper. Elif Akdag was involved in formatting the footnotes. Funding: The authors were leading and core researchers in the project named “GETTING READY FOR THE NEXT PAN- DEMIC: Questioning Vaccine Mandates over COVID-19 and Childhood Vaccinations.” This project was funded by a grant from The Scientific and Technological Research Council of Türkiye (Grant Number: 122K378) and Altinbas University (Grant Number: PB2021-HUKUK-1). Conflicts of Interest: none

A scoping review of COVID-19 vaccine hesitancy: refusal rate, associated factors, and strategies to reduce.

This study aimed to investigate the evidence regarding vaccine hesitancy including refusal rate, associated factors, and potential strategies to reduce it. This is a scoping review. Three main databases such as PubMed, Scopus, and Web of Science were searched from 1 January 2020 to 1 January 2023. All original studies in the English language that investigated one of our domains (vaccine hesitancy rate, factors associated with vaccine hesitancy, and the ways/interventions to overcome or decrease vaccine hesitancy) among the general population were included in this study. The data were charted using tables and figures. In addition, a content analysis was conducted using the 3C model of vaccine hesitancy (Confidence, Complacency, and Convenience) that was previously introduced by the WHO. Finally, 184 studies were included in this review. Of these, 165, 181, and 124 studies reported the vaccine hesitancy rate, associated factors, and interventions to reduce or overcome vaccine hesitancy, respectively. Factors affecting the hesitancy rate were categorized into 4 themes and 18 sub-themes (contextual factors, confidence barriers, complacency barriers, and convenience barriers). Vaccine hesitancy (VH) rate and the factors affecting it are different according to different populations, contexts, and data collection tools that need to be investigated in specific populations and contexts. The need to conduct studies at the national and international levels regarding the reasons for vaccine refusal, the factors affecting it, and ways to deal with it still remains. Designing a comprehensive tool will facilitate comparisons between different populations and different locations.

Pandemic perspectives from detained youth during COVID-19: Bridging the knowledge gap for future safeguards.

Despite the worsening health disparities among youth in detention during the COVID-19 pandemic, there has been minimal exploration into the pandemic experiences of detained youth and opportunities for pandemic mitigation. This paper analyzes the perspectives of youth in detention on the pandemic, including the effect of the pandemic on their detention experience and their perceptions about COVID-19 vaccination. The study used purposive sampling to recruit 16 participants (aged 14-17 years) from two juvenile detention centers in the urban Midwest. We conducted semi-structured interviews and analyzed verbatim transcripts using a hybrid deductive-inductive approach and thematic analysis. Four themes emerged: 1) personal experience influenced youth perceptions of pandemic severity and risk; 2) distrust and misconceptions contributed to youth vaccine hesitancy or refusal; 3) desired opportunities and parental opinion motivated youth to get the COVID-19 vaccine; and 4) pandemic mitigation strategies negatively impacted youths' detention center experience. Study findings identify opportunities for detention centers to minimize the negative impacts of pandemic mitigation strategies on youth in detention, expand vaccination knowledge and uptake, and build trust to positively impact the health and wellbeing of detained youth currently and during future pandemics.

Moral values and vaccination behavior in Russia during the COVID-19 pandemic

ObjectiveEffective persuasive communication necessitates message matching; the conveyed message should resonate with the recipient's characteristics, including individual moral values. While studies examining the relationship between moral values and vaccination behavior have been conducted in a limited number of countries, this study seeks to provide evidence on this relationship beyond Western democracies. MethodsA cross-sectional online survey was conducted from November 4 to December 17, 2021, in Russia. Participants reported their COVID-19 vaccination behavior and completed the Moral Foundations Questionnaire, designed to measure the endorsement of moral values (n = 415). Regression analysis was employed to assess the association between each moral foundation and COVID-19 vaccination behavior. ResultsOur findings indicate that the moral foundations of Care, Loyalty, Fairness, and Sanctity significantly influence vaccination behavior. Individuals who strongly endorse Fairness (AME = −0.019; 95 % CI = −0.033, −0.005) and Sanctity (AME = −0.016; 95 % CI = −0.031, −0.002) were less likely to be vaccinated. Conversely, individuals endorsing Care (AME = −0.018; 95 % CI = −0.031, −0.005) and Loyalty (AME = −0.015; 95 % CI = −0.028, −0.001) were less likely to report refusal of vaccination. These results remain robust after adjusting for sociodemographic variables related to vaccination barriers. ConclusionOur findings carry public health implications; an understanding of the moral psychology underlying vaccination behavior can facilitate more targeted and effective health communication. Employing skillfully crafted moral appeals may mitigate negative attitudes toward vaccination and enhance vaccination rates.

COVID-19 vaccine refusal is driven by deliberate ignorance and cognitive distortions

Vaccine hesitancy was a major challenge during the COVID-19 pandemic. A common but sometimes ineffective intervention to reduce vaccine hesitancy involves providing information on vaccine effectiveness, side effects, and related probabilities. Could biased processing of this information contribute to vaccine refusal? We examined the information inspection of 1200 U.S. participants with anti-vaccination, neutral, or pro-vaccination attitudes before they stated their willingness to accept eight different COVID-19 vaccines. All participants—particularly those who were anti-vaccination—frequently ignored some of the information. This deliberate ignorance, especially toward probabilities of extreme side effects, was a stronger predictor of vaccine refusal than typically investigated demographic variables. Computational modeling suggested that vaccine refusals among anti-vaccination participants were driven by ignoring even inspected information. In the neutral and pro-vaccination groups, vaccine refusal was driven by distorted processing of side effects and their probabilities. Our findings highlight the necessity for interventions tailored to individual information-processing tendencies.

Occurrence of adverse events following vaccination in patients with allergies: a prospective study.

Allergic patients may be concerned about more frequent and/or more severe adverse events following vaccination, which may lead to the refusal of vaccines among these patients. The aim of this study is to assess whether allergic patients have more frequent adverse events (AEs) after vaccination than healthy individuals. Study participants (N = 591) underwent vaccination of their choice at a selected Vaccination and Travel Medicine Centre. At a 10 to 14-day interval, they were contacted for a telephone questionnaire survey on the occurrence of AEs after vaccination. A group of allergic patients (n = 188) and healthy controls (n = 403) were followed in the study. No significant difference was found in the occurrence of AEs between study and control group. Only in redness and swelling, which was more common in allergic patients, but only in a few individuals. All side effects were minor, such as pain at the injection site or fatigue. No participant experienced a serious or life-threatening adverse event. In the studied group, no statistically significant differences were found even in the occurrence of AEs after singular vs. simultaneous administration of vaccines (p = 0.094), nor after vaccination with inactivated vs. attenuated vaccines (p = 0.655), or after vaccination against bacterial vs. viral infections (p = 0.140). Vaccination of allergic patients did not cause more frequent and/or more serious adverse events in our study compared to healthy people. If general contraindications are observed, then vaccination of allergic patients is considered safe.

“I Don’t Understand How These Two Things Go Together”: Toward a Theory of Risk Ecologies

ABSTRACT Rhetorical ecological approaches, which posit that messages exist not as isolated entities but instead in the relations of a dynamic network, offer a valuable lens for examining the discursive construction of health-related risk. Drawing from interview data (n = 50) exploring maternal vaccine refusal, this article expands upon these frameworks to trace how intertextual, synchronous messages – particularly those associated with prenatal and infant nutrition – influence mothers’ understanding about early childhood vaccine-related risk. Ultimately, I propose the notion of a risk ecology – a network of intertextual messages which shape and constrain sense-making about risk as it emerges within a particular moment and biosocial community.

Specialized Vaccine Care for Adverse Events Following Immunization and Impact on Vaccine Hesitancy in the Military Health System.

The World Health Organization identified vaccine hesitancy as one of the top 10 threats to global health. Vaccine hesitancy is defined as a delay in acceptance or refusal of vaccination despite the availability of vaccination services. Because vaccine safety concerns are important contributors to hesitancy, people who have experienced adverse events following immunization (AEFI) may be at especially high risk for subsequent vaccine hesitancy. The Defense Health Agency Immunization Healthcare Division (DHA IHD) provides specialized vaccine care to persons who have experienced AEFI. The impact of this specialized vaccine care on subsequent vaccine hesitancy has not been fully explored. A cohort of patients (n= 146) was identified among those who received consultative care from DHA IHD clinicians for AEFI concerns between April 2017 and September 2022. Analyses were restricted to non-uniformed beneficiaries of the Military Health System (MHS). Uniformed beneficiaries of the MHS were excluded from this analysis since vaccination mandates preclude the use of vaccine uptake as a measure of vaccine hesitancy. Outcomes were evaluated by reviewing MHS vaccination records after initial AEFI consultation through January 2023. Vaccine acceptance was considered the inverse of hesitancy, and was defined by: (a) receipt of any subsequent vaccination, (b) receipt of seasonal influenza vaccine, (c) receipt of subsequent doses of the AEFI-associated vaccine, if clinically recommended, and (d) receipt of COVID-19 vaccine. A diverse group of patients with a wide range of AEFI concerns received specialized vaccine care from DHA IHD clinicians during this period. Among the cohort, 78% of patients received any subsequent vaccination, 55.2% received seasonal influenza vaccine, 57.8% received a subsequent dose of their AEFI-associated vaccine when the vaccine was clinically recommended, and 48.9% received COVID-19 vaccine. The proportion of patients who received influenza vaccine exceeded the reported rate of influenza vaccine uptake by the general population during this time period. Specialized vaccine care after AEFI concerns was associated with relatively high acceptance of subsequent vaccinations. The experiences of DHA IHD clinicians, in providing specialized vaccine care to AEFI patients, may serve as a model for other organizations that are working to reduce vaccine hesitancy, even beyond the MHS.

Epidemic in the time of the COVID-19 pandemic: News media framing of the MMR vaccination controversy in Serbia

Rising vaccine hesitancy is often related to negative vaccination media coverage. It is generally accepted that the media played a great role in spreading the MMR (measles, mumps, and rubella) childhood vaccination scare first in the UK and then worldwide. During the COVID-19 pandemic, the MMR vaccination rate dropped further in some countries. This paper examines the Serbian news media framing of the MMR vaccination controversy in the period 2019–2023 (periods of declining MMR vaccination rate, rising COVID-19 vaccine hesitancy and the 2023 measles outbreaks). Furthermore, the paper questions whether the COVID-19 pandemic influenced the MMR vaccine narrative in the newspapers. For this reason, quality content analysis of the press in combination with framing approaches (diagnostic–prognostic–motivational framing tasks and responsibility framing) were used. In total, 122 articles dealing with the MMR vaccine and measles epidemics were analysed. According to the press, the most significant cause of the declining MMR rate is anti-vaccination campaigns and conspiracy theories by the “anti-vax lobby” (diagnostic frames). The pandemic was the other significant cause for the intake drop. Achieving herd immunity through vaccine uptake is offered as the best solution (prognostic frames). Finally, MMR vaccination campaigns and penalties for non-compliant parents and vaccine refusers are proposed as calls to action (motivational frames). During this period, the press did not publish any “sensational anti-vax stories”. Considering the low MMR vaccine numbers in Serbia in this period, positive media messages did not have a significant influence on improving the vaccination rate. Thus, I suggest that Serbian parents distrust vaccination information presented by the dominant news, including the advice of health experts.

Influences of HPV disease perceptions, vaccine accessibility, and information exposure on social media on HPV vaccination uptake among 11,678 mothers with daughters aged 9–17 years in China: a cross-sectional study

BackgroundMothers play a crucial role in influencing their daughters’ HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels.MethodsFrom July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data.ResultsAmong 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake.ConclusionsThese findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls.

Social Stigma and COVID-19 Vaccine Refusal in France

Context: In 2021, French health authorities strongly promoted vaccination against COVID-19. The authors assumed that refusing this vaccine became a stigma, and they investigated potential public stigma toward unvaccinated people among the French population. Methods: A representative sample of the French adult population (N = 2,015) completed an online questionnaire in September 2021. The authors focused on participants who were already vaccinated against COVID-19 or intended to get vaccinated (N = 1,742). A cluster analysis was used to obtain contrasted attitudinal profiles, and the authors investigated associated factors with logistic regressions. Findings: Regarding attitudes toward unvaccinated people, a majority of respondents supported several pejorative statements, and a significant minority also endorsed social rejection attitudes. The authors found four contrasting attitudinal profiles: moral condemnation only (32% of respondents), full stigma (26%), no stigma (26%), and stigma rejection (16%). Early vaccination, civic motives for it, faith in science, rejection of political extremes, and being aged 65 or older were the main factors associated with stigmatizing attitudes toward unvaccinated people. Conclusions: The authors found some evidence of stigmatization toward unvaccinated people, but further research is needed, especially to investigate perceived stigmatization among them. The authors discuss their results with reference to the concept of “folk devils” and from a public health perspective.

Assessing vaccine hesitancy and vaccine literacy among the European prison population and staff: A multicentre observational study

Vaccination is the most efficient and cost-effective public health intervention. Prison population, for its low social distancing, constant turnover, and high percentage of migrants, should be an important target of vaccination campaign. However, vaccination coverage in prison is low. In this study we estimated vaccine hesitancy and vaccine literacy among the prison population and staff and assessed their correlation.We conducted a cross-sectional study in 13 prisons of 4 European countries. The sample included 847 people living in prison and 755 staff members. Through a structured questionnaire we assessed vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal and socio-demographic characteristics of participants. Exploratory factor analysis was used to extract three components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; linear regression was applied to assess the association between vaccine hesitancy and vaccine and general health literacy. All analyses were adjusted for socio-demographic variables.We identified three components of vaccine hesitancy explaining 49% of the total variance: Mistrust, Concern and Conspiracy. In both people living in prison and staff, all the components were associated to previous vaccine refusal (p-value < 0.001) and presented good internal consistency (Cronbach’s alpha = 0.90, 0.73 and 0.78). Young participants presented the highest levels of vaccine hesitancy; migrant people living in prison had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were inversely associated with general health literacy (all p-values < 0.001).This study suggests that educational interventions aimed at increasing vaccine literacy in people living and working in prison could decrease vaccine hesitation and consequently increase vaccination uptake among the prison population and staff.