Vaccine Hesitancy Research Articles

Prevalence and sociodemographic correlates of COVID-19 vaccine acceptance in 20 European countries

Abstract Our study aimed to analyze the prevalence and socio-economic factors associated with COVID-19 vaccine hesitancy using individual data from representative national samples of 20 European countries. Data from round 10 of the European Social Survey, collected from May 2021 to September 2022, were analyzed. Prevalence (with a 95% confidence interval (CI 95%)) of participants’ intention to get vaccinated against COVID-19 was calculated. Crude differences in vaccine hesitancy proportions across sociodemographic strata were assessed using the Chi-square test. There were 31,771 adult participants (46.0 % men). The percentage of those hesitant (i.e. those who were not already vaccinated and intended not to be) toward the COVID-19 vaccine was 18.0% (CI 95% 17.6 - 18.4). Men and women were equally hesitant (18.0% vs. 18.0%, p = 0.93). There were differences between those under 40 (22.9%), adults between 40 and 59 (18.1%), and those over 60 (14.3%, p < 0.001). The unemployed had a higher proportion of hesitancy (32.9%) compared to the employed (17.4%), retirees (14.8%), and students (21.1%, p < 0.001). People living in rural areas have higher levels of hesitancy compared to those in urban areas (19.3% vs. 17.3%, p < 0.001). The estimates indicate that the highest prevalence of vaccine hesitancy was in Bulgaria (61.6%), Slovenia (40.4%) and Slovakia (30.7%), while Iceland (2.3%), Portugal (3.6%) and Italy (4.0%) had the lowest. Our study confirms high prevalence and high variability of hesitancy towards COVID-19 vaccines in Europe and identify groups for potential targeted interventions.

Vaccination in the post pandemic era - a qualitative study of the experiences of Somali immigrants

Abstract Background The Somali population is the largest non-European immigrant group in Norway and past studies have indicated lower coverage for both childhood vaccines and COVID-19. However, little is known about views and experiences of vaccination among this group and how their experiences might impact their vaccination decision-making process. This study explored views and experiences with vaccination among Somali immigrants in Norway. Methods We conducted semi-structured interviews with 15 participants in the fall of 2022. To better understand the participants’ perceptions of vaccine information, the data was inductively analyzed using a reflexive thematic analysis. Results Based on the thematic analysis, we focused on four sub themes: 1) the impact of COVID-19 on views of vaccines; 2) new versus old vaccines; 3) childhood vaccination; 4) trust in vaccines. The study found that the participants’ experiences during the pandemic have impacted their views on vaccination in general. Many of the participants expressed positive views and high levels of trust in the Norwegian health authorities and their vaccination recommendations. It was found that having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness. Viewing vaccines as new and insufficiently tested or researched, as well as lacking information about potential side-effects, increased participants’ hesitancy when faced with vaccination decisions. Among the parents in this study, postponing the measles-mumps-rubella-vaccine due to fear of autism was a common occurrence. Conclusions The current study fills an important gap in knowledge about views, experiences, and vaccination decisions among the Somali population in Norway. Knowledge from this study can help adapt better vaccine information and further improve the prevention of infectious diseases in Norway in general and for under-vaccinated groups in particular. Key messages • Having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness. • Viewing vaccines as new and insufficiently tested/researched, as well as lacking information about potential side-effects, increased participants’ vaccine hesitancy.

Public views on open data health research in Switzerland: Implications for research and policy

Abstract Background The increasing volume of publicly available data offers health researchers opportunities to explore public sentiment through open data research on issues such as vaccination hesitancy and fake news propagation. To ensure ethical conduct and maintain public trust, assessing public perceptions of open data research in healthcare is crucial. Methods We conducted 10 focus groups across the German, French, and Italian-speaking regions of Switzerland. We presented participants with real-world examples of open data research in healthcare and guided discussions using a semi-structured format. The topic areas were: (1) using Twitter data to assess public opinion on gene-editing technology, (2) assessment of health policy documents, (3) using Twitter data to predict individual health status and (4) using YouTube data to assess public sentiment on health policies. We assessed our findings using a thematic analysis approach. Results Gathering insights from 75 citizens, four major themes emerged: (1) Expectations towards actors and open data research, such as using research findings for societal benefit, and ensuring transparency in data use through informed consent; (2) Supportive measures including communication strategies to raise awareness and inform the public about the use of publicly available data for health research; (3) Concerns about data reuse for purposes beyond the study’s objectives, especially for financial gain, and about data validity and privacy, particularly for sensitive health data; and (4) Mitigative measures to minimize harm, such as through the involvement of external oversight committees. Conclusions Our findings indicate public support for open data research in healthcare, provided that specific expectations are met. Developing a guiding framework for legitimate open data research in healthcare is a valuable next step, with a focus on enhancing public awareness through communication campaigns and providing oversight measures to foster public trust. Key messages • Open data research in healthcare relies on public data use without explicit consent, which can disconnect the research community from society. • We found that public support for open data research in healthcare is generally present, however it is also conditional on communication and policy efforts addressing their concerns.

The Scourge of measles

Abstract Once considered a disease of the past, the resurgence of measles in England has garnered significant attention in recent weeks and months. The uptake of routine childhood vaccines including the measles, mumps and rubella (MMR) vaccine is the lowest it has been in a decade and is well below the 95% uptake needed to protect the population and prevent outbreaks. This is giving this serious disease a chance to get a foothold in our communities. From having never seen a case of measles in their life time doctors in England are now notifying cases of measles based on clinical suspicion. Since October, we have seen a rapid increase in both measles cases and outbreaks of measles across England (the total number of cases confirmed since October 2023 to date is 1109) and it has been declared a national incident. The abstract highlights the consequences of vaccine hesitancy, illustrated by case studies of outbreaks of measles among susceptible populations such as schools and prisons and the steps being taken to control the spread. Social media misinformation, distrust in healthcare authorities, and concerns over vaccine safety are some of the factors shaping parental attitudes towards MMR vaccination. In response to these challenges, the abstract underscores the importance of targeted interventions aimed at addressing vaccine hesitancy, such as community engagement initiatives, tailored communication strategies, and healthcare provider training. By emphasizing the critical role of MMR vaccination in preventing measles resurgence, this abstract advocates for a collaborative approach involving healthcare stakeholders, policymakers, and the public to combat to combat this preventable yet persistent threat to public health.

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.

Preparing for future public health crises by fostering a conducive environment

Abstract Vaccination is considered one of the most cost-effective public health interventions. Zoonotic diseases, which are transmitted from animals to humans, represent an escalating global health concern. Environmental degradation, wildlife trade, and intensified farming practices have disrupted natural ecosystems. This has not only heightened the risk of pathogens crossing species barriers but exacerbated the migrant crisis and deepened global inequalities, as vulnerable populations disproportionally bear the environmental and health burdens. Despite decades of awareness about these risks, the COVID-19 pandemic highlighted our lack of preparedness. At the same time, vaccination hesitancy has been revealed as an important factor in implementing universal vaccination coverage at the population level. Urgency drove innovation. Within months, new multidisciplinary and interdisciplinary approaches were implemented that enhanced our capacity to understand, treat, and protect against the virus. This led to deploying novel technologies, curbing the crisis, and even opening the door to emerging health technologies across a wide spectrum of innovation, from new medicinal products, including vaccines, to evidence synthesis tools, including for modelling and forecasting. Shifting from emergency measures to long-term management of COVID-19, there lies a critical opportunity to strengthen resilience and to increase preparedness against future health threats. The EUVABECO project seeks to harness this momentum by initiating pilot projects that test innovative vaccination tools in evidence-based selected reference practices. These pilots are planned to use suitable theoretical frameworks and consensus meetings to design and develop comprehensive implementation plans that will be shared with EU MS, thereby enhancing Europe’s preparedness and response capabilities against communicable diseases.

Evaluating the psychological antecedents of vaccination in applicants to primary health care centers

Abstract Background Vaccine acceptance can be enhanced by understanding the psychological antecedents of vaccination. The 5C model identifies relevant factors: confidence, complacency, constraints, calculation, and collective responsibility. This study aims to evaluate these factors among primary health care center applicants in Ankara. Methods A total of 1712 individuals aged 18 and over, who visited primary health care centers, participated in the study. The face-to-face survey included questions about sociodemographic characteristics, Vaccination Psychological Antecedents Scale, individuals’ attitudes and behaviors towards vaccination, and internet usage. Factors with a significance level of p < 0.20 from previous analyses were assessed using multivariate logistic regression analysis. The factors influencing the decision to get vaccinated without hesitation when necessary were investigated. Results The likelihood of getting vaccinated without hesitation in necessary situations is higher among those with higher income than expenditure(OR:1,517, 95%CI=1,094-2,104), those without chronic diseases in their family(OR:1,411, 95%CI=1,109-1,795), and those who do not actively use social media(OR:1,380, 95%CI=1,051-1,813). Additionally, an increase in the confidence score(OR:1,276, 95%CI=1,239-1,315) and the collective responsibility score(OR:1,096, 95%CI=1,058-1,134), was associated with an increased likelihood, while an increase in the calculation dimension(OR:0,928, 95%CI=0,895-0,962) was associated with a decreased likelihood. Conclusions Income status, presence of chronic illness in the family, active social media usage, confidence, collective responsibility, and calculation are factors influencing vaccine acceptance without hesitation. Communication strategies based on trust and collective responsibility should be developed to improve vaccine acceptance. The risk factors causing vaccine hesitancy among social media users should be investigated, and measures should be taken. Key messages • Develop trust-based, collective responsibility-focused communication to boost vaccine acceptance. • Investigate and address social media-driven vaccine hesitancy.

The evolution of vaccine mandates: from historical perspectives to contemporary applications

Abstract Luigi Sacco pioneered efforts in 19th-century Italian vaccination campaigns when mandatory vaccination practices began as a public health strategy. We bridge past and present through a systematic review of both historical and contemporary vaccine mandate policies. While Sacco’s early initiatives, characterised by compulsory vaccination and effective communication strategies, set foundational principles for vaccine mandates, the modern era, especially during the COVID-19 pandemic, has seen a significant shift in the nature and application of vaccine mandates. Recent legislative changes across various countries have introduced stricter mandates aimed at managing public health crises. For instance, Italy and France, deeply impacted by reduced vaccine uptake and subsequent measles outbreaks, responded by reinforcing vaccine mandates. These countries aimed to mitigate the dual challenges of achieving high vaccination coverage and combating growing vaccine hesitancy. Comparative analysis of recent legislative changes reveals a trend towards increasing coerciveness in vaccine mandates, reflecting a blend of functional and political pressures driving government decisions. This trend is evident in the legislative adjustments made in California, Australia, France, and Italy, where heightened penalties and reduced exemptions were introduced to counteract declining public compliance. The synthesis of these experiences highlights the critical role of robust, credible communication and the nuanced application of mandates that consider societal and cultural contexts. Contemporary strategies are characterised by targeted interventions aimed at specific populations, reflecting the complex interplay of social, political, and health dynamics in vaccine policy. The enduring relevance of vaccine mandates underscores the necessity of flexible, responsive public health strategies that effectively address both long-standing and emergent vaccine hesitancy and coverage challenges. Speakers/Panelists Carlo Signorelli HSR, Milan, Italy Maria Gańczak Department of Infectious Diseases, University of Zielona Góra, Zielona Góra, Poland

A national job profile for infection control nurses in public health: the development and content

Abstract Background The COVID-19 pandemic emphasized the crucial role of infection control nurses (ICNs) in public health. ICNs working in multidisciplinary infection control teams face challenges, such as new infectious disease outbreaks and vaccination hesitancy. Recognizing the complexity in this domain, Dutch ICNs in municipal public health services expressed the need for a national job profile describing their tasks and responsibilities. Methods A mixed methods approach was used to develop a job profile. National and international documents on infection control professionals were studied by desk research. Insights from Dutch infection control professionals and experts were collected through a survey (n = 171), two interactive discussion meetings (18-22 participants) and meetings with an advisory group of stakeholders, including representatives of the Dutch nurses’ association. Descriptive statistics and deductive content analysis were used to analyze the data. Results The diverse methods facilitated the development of a job profile for Dutch ICNs. The profile describes that, within infection control teams, ICNs play a key role in coordinating and monitoring infection control measures. They facilitate collaboration among (at-risk) individuals, the infection control team, and the collaborating partners. Additionally, ICNs identify emerging risks for infection control and coordinate infection prevention activities in collaboration with the infection control team. During large-scale outbreaks, ICNs take a leading role and, where appropriate, delegate tasks such as contact tracing to crisis workers. Conclusions We developed the first job profile that outlines the tasks and responsibilities of ICNs in Dutch public health services. It contributes to strengthening infectious control services to face future challenges. Findings emphasize the ICNs’ pivotal role in coordinating and monitoring infection control efforts, while enhancing collaboration, even during large outbreaks. Key messages • In close collaboration with infection control professionals a robust job profile was developed, describing the tasks and responsibilities of infection control nurses in the Netherlands. • The new job profile contributes to strengthening the position of infection control nurses working in municipal public health services and infection control teams.

Safety of COVID-19 vaccines regarding cardiovascular events: a systematic review and meta-analysis

Abstract Background Since the outbreak of COVID-19, extensive vaccination strategies have almost excelled in reducing the mortality and severity of COVID-19 infection; however, although there are several authorized vaccines thus far, vaccine hesitancy has risen among various populations. Cardiovascular adverse events have been among the highly reported adverse events of the vaccines. Herein, we aimed to systematically assess the studies that reported the safety of COVID-19 outcomes regarding cardiovascular outcomes. Methods Three online databases were comprehensively searched, including PubMed, Scopus, and Embase. Relevant observational/interventional studies and case reports/series were included. Study characteristics, demographic features of the populations, vaccine type and dosage, and outcomes of interest were extracted. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the groups vaccinated and those that have not. Results From the 2960 initial searched records, 21 observational/interventional studies, and 110 case reports/series were included. Meta-analysis revealed that there is no difference between vaccinated and non-vaccinated regarding all new-onset cardiac disorders (RR 1.14, 95% CI 0.71 to 1.85, p-value=0.59). On the other hand, vaccinated patients had a higher risk of myopericarditis, compared to the general population by 74% (RR 1.74, 95% CI 1.56 to 1.94, p-value <0.01). There was no difference between the groups in terms of risk of myocardial infarction. Among 219 individuals reported in case reports and series, 193 were diagnosed with myocarditis and pericarditis. Notably, 95.34% of these patients were vaccinated with mRNA-based vaccines. Conclusion This systematic review and meta-analysis implied that there is no increase in overall new-onset cardiac adverse events, while there might be an increased risk of myopericarditis based on some studies’ findings. This highlights that since there is no added cardiovascular risk associated with COVID-19 vaccination, all individuals are encouraged to get vaccinated.Forest plots for meta-analyses

Leveraging Social Marketing to Increase Vaccination Rates: A Systematic Review

Abstract Introduction Vaccinations are crucial for protecting individuals from preventable diseases, serving as a cornerstone of public health, safeguarding entire populations. Low vaccination rates can have devastating consequences, leading to outbreaks of preventable diseases. Social marketing has had an increasing role to play in public health. This systematic review seeks to investigate social marketing effectiveness in boosting vaccination adherence. Methods A literature search was conducted in PubMed, Scopus and Cochrane Library, using keywords “social marketing”, ‘campaigns”, “vaccination”, “vaccination uptake”. The search was limited to English-language studies, including studies discussing social marketing campaigns and its impact on vaccination uptake. Prior to inclusion, the studies were evaluated for relevance and applicability to the research question. Included studies were analysed for methodology, sample size, data collection methods, and key findings. Results Of 198 articles identified, 26 studies met inclusion criteria. All studies reported demonstrable improvement in vaccination adherence and hence higher vaccination rates with the use of social marketing campaigns. Targeted messaging on social media allows communication to be tailored to specific demographics and address their unique concerns. Community engagement combats vaccine hesitancy by dismantling misinformation and rebuilding trust. Additionally, these campaigns leverage social influence and mobilise communities to cultivate pro-vaccine attitudes. By addressing personal choice, knowledge gaps, and hesitancy, social marketing paves the way for greater vaccination uptake. Conclusions Social marketing has been proven to be an effective tool in promoting vaccination adherence in public health. As vaccination remains a critical aspect of public health, the continued use of social marketing interventions is essential for improving vaccination rates and ultimately enhancing overall population health. Key messages • Social marketing campaigns lead to higher vaccination rates across various populations. • By addressing vaccine hesitancy, social marketing paves the way for increased vaccination uptake.

Public Health Literacy: a concept to develop – Qualitative study among public health professionals

Abstract Background Health literacy can be defined as individuals’ motivation and skills to access, understand, evaluate, and utilize information to make decisions about their health. Despite Sorensen’s widely used definition encompassing both individual and population levels, also known as Public Health Literacy, it remains poorly detailed and is rarely taken into account by measurement tools. As evidenced by the Covid-19 health crisis, limited public health literacy impacts reluctance to accept government recommendations, vaccine hesitancy, and fosters mistrust of science and conspiracy theories in the health field. The main objective of this study was to derive specific public health knowledge and skills from public health professionals for the general population constituted the first step of the development of a public health literacy measurement tools. Methods A qualitative study, based on ten semi-structured interviews with public health professionals from various settings (academic, hospital, health prevention, and promotion), working across various public health fields (nutrition, sexual health, mental health), has been conducted since March 2024. Results Preliminary analysis identified three main themes: (1) fundamental concepts including identification of health determinants, epidemiology and the purpose of public health interventions, (2) critical skills including the assessment of the level of evidence and reliability of public health information, and (3) civic orientation including environmental impact on health and community approach to interventions. Conclusions These detailed insights will guide the creation of a valid measurement tool for public health literacy. This will facilitate the investigation of specific impacts on people’s adherence to public health interventions or messages and the development of actions targeting literacy in a more holistic manner. Key messages • Specific public health dimensions have been identified to enrich the existed definition of health literacy. • Public health concepts, reliability of public health information and community approach constitute the core of public health literacy.

Vaccine awareness and hesitancy among Ukrainian refugee mothers in Bulgaria

Abstract Issue Migration carry out risk of disrupting the epidemiological well-being among refugees and host populations. Since the beginning of Ukraine crisis over 50 000 refugees remain in Bulgaria; 92% are women and children. There is suboptimal childhood immunization coverage among Ukrainian refugee community prior to arrival in Bulgaria. Description of the problem Childhood vaccination is mandatory in Bulgaria for TB, hepatitis B, diphtheria, tetanus, pertussis, poliomyelitis, rubella, measles, mumps, Haemophilus influenzae B and pneumococci. Refugees with uncertain immunization status are vaccinated according to the national immunization schedule and receive personal immunization card. As of March 2024, we conducted cross-sectional study to assess knowledge and attitudes of Ukrainian mothers through an interview. Results Of 105 mothers interviewed, 72.38% were with higher education. Arrived women were not familiar with Bulgarian health system and especially with vaccination. Absence of language barrier and presence of doctors among them facilitated our study.56.19% believe that migration has disrupted their children’s vaccinations. 56.19% consider that migration has disrupted their children’s vaccination. Aware of benefits of vaccines were 91,43%, they mainly trust doctors-84.76%, they pay attention to the positive discussion in the media-55.77%.Mothers realize the importance of herd immunity, considering that vaccinated children protect the others-68.57%.Leading reasons for mistrust of vaccines, mothers indicate - doubt in favor of vaccine-24.76%, medical contraindications for child-21.90% and doubts about quality of the vaccine-19.05%.They pay attention to positive discussion in the media-55.77% and have confidence in Bulgaria’s institutions. Lessons The Government of Bulgaria provided significant support and medical care for the prevention of vaccinepreventable diseases among Ukrainian children. Institutions and volunteers work for successful integration of refugees. Key messages • Need to know the immunization status of Ukrainian children admitted to Bulgaria. • Increasing trust in vaccines and the health system in general in Bulgaria requires additional explanatory campaigns among refugees.

Restoring trust in vaccination through collective engagement with key populations in Eastern Europe

Abstract Issue/problem COVID-19 vaccination rates remained below 50% in Moldova, North Macedonia, and Serbia, especially among vulnerable populations like pregnant women and those with chronic diseases. This was strengthened by a lack of targeted communication and training for healthcare workers, and COVID-19 fatigue. Strategies to increase vaccine demand and confidence are a global priority, especially among vulnerable populations. Description of the solution From May 2022 to April 2024, the USAID MOMENTUM Routine Immunization Transformation and Equity project employed behavior integration to design a social and behavior change strategy, centering on vaccination as a part of a healthy lifestyle. It was implemented through continuing medical education (CME) and community engagement (CE) workshops with vulnerable populations, supplemented by cross-country learning exchanges. The outcomes provide a framework for public health initiatives aimed at boosting vaccine uptake through innovative, behavior-based methods. Results 1,618 healthcare professionals, able to reach 2.5 to 4.8 million patients, received training in immunization, COVID-19 vaccines, and quality health service, and 99% indicated confidence in applying the knowledge. 265 CE workshops, engaging 4,079 patients, increased awareness and addressed concerns related to vaccination. Of 3,223 patients who were followed up, 47% reported setting an appointment with their doctor regarding vaccination, 27% discussed vaccination with their partners, and 7% proceeded to receive the COVID-19 vaccine. Lessons Behavior Integration helped address key barriers to vaccination and informed the design of strategies (i.e. situating COVID-19 vaccination as part of a healthy lifestyle). Establishing trust with healthcare providers and patients through collective engagement improved health behaviors. Focusing on health as a wider priority helped re-establish the significance of vaccination as part of a healthy lifestyle. Key messages • Behavior science and behavior integration helped identify and address barriers, as well as design tailored interventions to improve vaccination demand and confidence. • Collective engagement, focused on integration of COVID-19 vaccination as part of a healthy lifestyle, achieved results through addressing vaccine hesitance from both sides of the equation.

From hesitancy to decision: shifts from intentions to uptake of Influenza and COVID-19 vaccines

Abstract Background Vaccine hesitancy is context-related and risks coverage. In a context of growing hesitancy, this study aims to characterize and identify factors underlying shifts in Influenza and COVID-19 vaccines intention and uptake. Methods Questionnaires were administered to a random sample of the 60+ years old Portuguese population (n = 1400), before (Q1) and at the end of the campaign (Q2). Sociodemographic, clinical data and intention to Influenza/COVID-19 vaccine uptake, using a Likert-scale (0-2: refusal; 3-7: hesitancy; 8-10: acceptance), were assessed on Q1. On Q2, self-reported vaccination status and motives. A logistic regression was performed to identify underlying factors. Results COVID-19 vaccine: 26.2% of those reporting acceptance went for non-uptake (214/818), stating low susceptibility/severity and fear of side effects. Factors associated were not having chronic disease (OR 2.07, p<.05) and age 60-64 (OR 4.16, p<.05). 25.5% of those who refuse went for vaccine uptake (27/106), stating self-initiative. Age 65 + (OR 43.82, p<.05) was associated with the shift; 56.4% of the hesitant individuals went for non-uptake (154/273). Higher education associates with non-uptake (OR 0.53, p<.05). Influenza vaccine: 11.5% of reported acceptance went for non-uptake (100/873), stating low susceptibility/severity. Associated factors were age 60-64 (OR 5.85, p<.05), not having chronic diseases (OR 2.64, p<.05) and living alone (OR 2.34, p<.05). 23.4% of those refusing decided for vaccine uptake (29/124), stating self-initiative/risk awareness. Associated factor was age 60-64 (OR 6.41, p<.05). 69.5% of hesitancy went for uptake (139/200). Chronic disease associates with non-uptake (OR 0.26, p<.05). Conclusions Intention is a good predictor but not decisive for uptake. This research provides better understanding of shifts in intention versus vaccine uptake, as well as factors and motives for hesitancy, allowing more robust interventions ahead of a vaccination campaign. Key messages • For the Influenza vaccine, 13% of individuals reporting acceptance or refusal changed their mind. From the group reporting hesitancy, 70% decided for vaccine uptake. • For the COVID-19 vaccine, 26% of individuals reporting acceptance or refusal changed their mind. From the group reporting hesitancy, 56% decided for non-vaccine uptake.

COVID-19 vaccine effectiveness and hybrid immunity in the respiratory season of 2022-23 in Hungary

Abstract Background There has been an increase in COVID-19 vaccine hesitancy among the general population, accompanied by a decline in confidence that vaccines provide adequate protection. We estimated the effectiveness of the COVID-19 vaccines (CVE) and hybrid immunity against medically attended COVID-19 during the 2022-2023 respiratory season in Hungary. Methods We conducted a test-negative design study involving 68 GPs. Patients aged ≥18 years presenting with acute respiratory infection were swabbed. Cases and controls were patients testing positive and negative for SARS-CoV-2 by RT-PCR, respectively. Exposure was defined as having received at least one COVID-19 booster dose, taking into account the time since the last vaccination. CVE was estimated using logistic regression, adjusted for symptom onset date, age, chronic condition and sex. Results We included 247 cases and 1073 controls in the analysis. 196 samples were sequenced, and Omicron BA.5, BQ.1 and XBB.1 were the most frequent sub-variants. The CVE was 52.9% (95% CI: 15.2-73.9%), and 72.3% (95% CI: 32.0-88.7%) in the 18-59, and 60+-year-old population who received the final dose within the past year, respectively. Self-reported COVID-19 in the previous 60-365 days did not confer protection against reinfection, however, when combined with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: −28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively. Conclusions Booster vaccination within one year after the last dose confers significant protection against symptomatic infection, particularly among the elderly. Those who have previously been infected with SARS-CoV-2 may also benefit from booster vaccinations. Key messages • COVID-19 booster campaigns must be intensified, focusing mainly on the elderly. • Providing clear guidance on the timing and target groups of vaccination and emphasising the benefits of vaccination can help to achieve higher coverage.

Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study.

Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents' preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.

Cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitudes Examination (VAX-U) scale.

Martin and Petrie developed the Vaccine Attitudes Examination (VAX) scale with an aim to document general vaccination attitudes. Vaccine acceptance plays an important role in curbing COVID-19 infections. Thus, it was important to assess vaccination attitudes of Pakistani people towards novel COVID-19 vaccines. The VAX scale was not available in Urdu language for Pakistani population. The study aimed to carry out cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitude Examination (VAX) scale in a selected population sample from Pakistan. A cross sectional study was conducted in September 2021 in an outpatient department of a healthcare facility in Karachi, Pakistan. Adult visitors, eligible for COVID-19 vaccine and spoke Urdu as first language were invited. Convenient sampling was used, and sample size was based on an item response ratio of 1:20. An Urdu version of the VAX scale was developed. The reliability was assessed using Cronbach's alpha (α) and intraclass correlation coefficient (ICC). The model fitness was evaluated using confirmatory factor analysis (CFA) and fit indices namely goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). A structural equation model (SEM) was also developed. IBM SPSS and AMOS were used to analyse the data. The study had ethical clearance. A total of 211 responses were analysed. The reliability (Cronbach's α) was 0.821. The ICC was 0.831 (95% CI: 0.795-0.863). CFA using a 4-factor model revealed the following values for fit indices; GFI = 0.944, AGFI = 0.909, TLI = 0.953, CFI = 0.966, and RMSEA = 0.051. All values reported were in the acceptable range. The VAX Urdu version is a reliable and valid instrument for use in an Urdu speaking population and will enable clinicians to assess the public's attitude towards general vaccination including COVID-19 vaccination. Clinicians can use the VAX-U to document a person's vaccine hesitancy and tailor their counselling to address the issues in vaccine uptake.

Use of mobile communication technology to overcome vaccine skepticism

Despite significant advances in clinical medicine, infectious diseases and their prevention remain the leading problem of our time. Low literacy of the population reggarding immunization, combined with high activity of the anti-vaccination movement, creates unhealthy skepticism about immunoprophylaxis and the risks of epidemics. The work uses theoretical analysis of literature, methods of anonymous questionnaires of students of medical and non-medical specialties, methods of statistical and bioinformatics data processing, and modern internet technologies: the platform of the social network “Vkontakte” and the program for creating a chatbot “Senler”. The analysis of commitment to vaccination of medical and non-medical students showed that 65.8% to 96.2% of respondents have a positive attitude to preventive health measures. From 1.9% to 6% believe the disease is easier to treat than to prevent, and almost 30% of respondents do not think about prevention and diseases in general, considering themselves young. Almost 10% of non-medical students (1 group) consider vaccination useless, 8.4% dangerous for immunity, 18.3% know nothing about vaccinations and cannot compare the benefits of vaccination with the risk of infectious pathology. In order to form medical literacy of the population, including in strategic issues of preserving the health of the nation, the team of authors developed and implemented through the social network “Vkontakte” chatbot “Vaccine and point” containing up-to-date information about vaccines, methods multiplicity and age features of their use. People [n = 156] used the chatbot during the month of work, noting its high informational value, motivating to vaccination. Analysis of commitment to vaccination of students of medical and non-medical specialties showed an insufficient level of trust in domestic preventive medicine, which forms an unhealthy attitude to vaccine prevention. Insufficient vaccine coverage creates real threats to the spread of infectious diseases at the population level. Developed and implemented in real practice, the “Vaccine and point” chatbot is an effective tool for increasing the knowledge of compatriots about the real possibilities of protection against the main vaccine-controlled infections and an additional attempt to overcome anti-vaccination skepticism.

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.