Search

Background In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. Methods Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. Results One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. Conclusions The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity. [ABSTRACT FROM AUTHOR]

Background Vaccine hesitancy threatens public health. Some evidence suggests that vaccine hesitancy in Europe may be linked with the success of populist parties, but more systematic analysis is needed. Methods We examine the prevalence of individual-level vaccine hesitancy across the European Union (EU) and its association with political orientations. We also analyze whether success of populist parties is linked with vaccine hesitancy and uptake. We draw on individual-level Eurobarometer data from 2019, with a total of 27 524 respondents across the EU. We also rely on national and regional-level populist party vote shares. Finally, for a time-series analysis, we rely on aggregated populist party support as measured in the European Social Survey waves 1–9 (2002–18), and national immunization coverage rates from the WHO from 2002 to 2018. Results While vaccine hesitancy is confined to a minority of the population, this group is large enough to risk herd immunity. Political orientations on a left-right dimension are not strongly linked to vaccine hesitancy. Instead, vaccine hesitancy is associated with anti-elite world views and culturally closed rather than cosmopolitan positions. Conclusions Vaccine hesitancy is not only present in all EU member states but also maps on broader dimensions of cultural conflict. Hesitancy is rooted in a broader worldview, rather than misperceptions about health risks. Pro-vaccine interventions need to consider the underlying worldview, rather than simply targeting misperceptions. [ABSTRACT FROM AUTHOR]

Background Vaccine hesitancy is relevant for healthcare professionals (HCPs) who face challenges in building trusting relationships with patients. Accordingly, the VAX-TRUST project has been developed to improve experiences of HCPs and patients dealing with vaccinations. To support VAX-TRUST, this work aimed to identify latest interventions targeted at HCPs to address hesitancy and increase vaccine uptake. Methods A systematic review was conducted according to PRISMA by searching PubMed, Scopus and Embase. The protocol was registered on PROSPERO. Articles were eligible if evaluated interventions directly targeted at HCPs/healthcare students. The search was run on 26 January 2022. Articles published in 2016 or after were included. Results A total of 17 492 records were identified; 139 articles were selected. Most articles were set in USA (n  = 110). Over half had a pre–post design without a control group (n  = 78). A total of 41 articles focused on single-component interventions, 60 on multi-component interventions involving only HCPs and/or students and 38 on multi-component interventions involving also other professionals. Main components were in-person education (n  = 76), synchronous (n  = 10) and asynchronous (n  = 23) online learning, educational materials (n  = 26), performance assessment and feedback (n  = 33), electronic record changes (n  = 30), role play/simulation (n  = 21) and online games/apps (n  = 5). Educational sessions were mainly about scientific update or communication. Outcomes of interventions were grouped in: vaccination rates (n  = 69), knowledge (n  = 32), attitudes (n  = 26), confidence in counselling (n  = 30) and acceptability (n  = 16). Conclusions Apps, gaming, role play/simulations could represent innovative interventions. This review highlighted the need of delving into communication strategies and using more robust evaluations, longer follow-up and standardized measurements. [ABSTRACT FROM AUTHOR]

Background Women have been significantly more likely than men to express hesitancy toward COVID-19 vaccination and, to a lesser extent, to refuse vaccination altogether. This gender gap is puzzling because women have been more likely to perceive higher risks from COVID-19, to approve more restrictive measures to fight the pandemic and to be more compliant with such measures. Methods This article studies the gender gap in COVID-19 vaccination attitudes using two nationally representative surveys of public opinion fielded in February 2021 and May 2021 in 27 European countries. The data are analyzed using generalized additive models and multivariate logistic regression. Results The data analyses show that hypotheses about (i) pregnancy, fertility and breastfeeding concerns, (ii) higher trust in Internet and social networks as sources of medical information, (iii) lower trust in health authorities and (iv) lower perceived risks of getting infected with COVID-19 cannot account for the gender gap in vaccine hesitancy. One explanation that receives support from the data is that women are more likely to believe that COVID-19 vaccines are unsafe and ineffective and this leads them to perceive the net benefits of vaccination as lower than the associated risks. Conclusions The gender gap in COVID-19 vaccine hesitancy results to a large extent from women perceiving higher risks than benefits of the vaccines. While accounting for this and other factors decreases the gap in vaccine hesitancy, it does not eliminate it completely, which suggests further research is needed. [ABSTRACT FROM AUTHOR]

Background Far-right politicians in several countries have been vocal opponents of COVID-19 vaccination. But can this threaten vaccine roll-out? Methods We take advantage of repeated cross-sectional surveys with samples of around 3800 individuals across Spain conducted monthly from December 2020 to January 2022 (n  = 51 294) to examine any association between far-right politics and vaccine hesitancy through the whole vaccine roll-out. Results Consistent with prior data, we found that far-right supporters were almost twice as likely to be vaccine-hesitant than the overall population in December 2020, before vaccines became available. However, with a successful vaccine roll out, this difference shrank, reaching non-significance by September 2021. From October 2021, however, vaccine hesitancy rebounded among this group at a time when the leadership of the far-right promoted a 'freedom of choice' discourse common among anti-vax supporters. By the latest month analysed (January 2022), far-right voters had returned to being twice as likely to be vaccine-hesitant and 7 percentage points less likely to be vaccinated than the general population. Conclusions Our results are consistent with evidence that far-right politicians can encourage vaccine hesitancy. Nonetheless, we show that public attitudes towards vaccination are not immutable. Whereas a rapid and effective vaccine rollout can help to overcome the resistance of far-right voters to get vaccinated, they also seem to be susceptible to their party leader's discourse on vaccines. [ABSTRACT FROM AUTHOR]

Background Routine childhood vaccination programs have had enormous positive public health impacts worldwide. However, in some areas, these benefits may be impeded by vaccine hesitancy and undervaccination. We estimated the number of reported cases of measles, pertussis, mumps and poliomyelitis averted in Sweden after the introduction of routine childhood vaccination programs. Methods We used annual national data on population size and the number of reported cases of measles (1911–2019), pertussis (1911–2019), mumps (1914–2019) and poliomyelitis (1910–2019) for Sweden. For each disease, we calculated the median and 95% confidence interval of the annual pre-vaccination incidence to estimate the number of counterfactual cases; that is, the estimated number of cases that would have been observed in the post-vaccination period had no vaccine been introduced (median incidence × average annual population). For the post-vaccination periods, we calculated reported cases averted and assumed all decreases were due to vaccines. Results In total, for all four diseases combined, over 2.1 million cases were reported over the respective surveillance periods. Since the introduction of vaccinations, we estimate that over 1.5 million reported cases of these four diseases combined have been averted: measles (633 091), pertussis (608 670), mumps (262 951) and poliomyelitis (58 240). However, due to underreporting, especially during pre-vaccination years, these are likely underestimates. Conclusions Since the introduction of these routine childhood vaccination programs in Sweden, a substantial number of reported cases of vaccine-preventable diseases have been averted. Vigilance against both failure to vaccinate and undervaccination is necessary to prevent future increases of these vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Background Conspiracy beliefs can be a major hindrance causing a lack of compliance with public health measures, including vaccination. We examined the relationship between individual attitudes, socio-demographic factors, conspiracy beliefs, COVID-19 vaccine hesitancy and preferences about pandemic policies in Europe. Methods We used data from the 10th round of the European Social Survey, conducted in 2021–22 in 17 European countries. Both a conspiracy index and a personal attitude index for each participant were built by using a Latent Class Analysis model. Then, we used a multilevel regression model to investigate the relationship between a personal attitudes index, socio-demographic factors and country of residence, and a conspiracy index. We descriptively analyse the relationship between the conspiracy index and four main items related to COVID-19. Results We found that a higher probability of believing in conspiracy theories was associated with male gender, middle age, lower levels of education, unemployment, lower levels of trust and satisfaction and right-wing political orientation. The country of residence was a contextual factor, with eastern European countries having higher levels of conspiracy beliefs. Individuals who expressed conspiracy beliefs had lower COVID-19 vaccine uptake, were less satisfied with the way health services coped with the pandemic and less supportive of governmental restrictions. Conclusions This study provides valuable insights into the factors associated with conspiracy beliefs and their potential impact on public health. The findings highlight the need for effective strategies to address the underlying factors driving conspiracy beliefs, reduce vaccine hesitancy and promote acceptance of public health interventions. [ABSTRACT FROM AUTHOR]

Background The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. Methods In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. Results The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. Conclusions It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives. [ABSTRACT FROM AUTHOR]

Background Vaccine hesitancy is a growing issue globally amongst various populations, including health care providers. This study explores the factors that influence vaccine hesitancy amongst nurses and physicians. Methods We performed a qualitative meta-synthesis of 22 qualitative and mixed-method studies exploring the factors that may contribute to vaccine hesitancy amongst nurses and physicians. We included all articles that mentioned any aspect of trust concerning vaccination, including how trust may influence or contribute to vaccine hesitancy in nurses and physicians. Results Our findings revealed that vaccine hesitancy amongst nurses stemmed predominantly from two factors: distrust in health authorities and their employers, and distrust in vaccine efficacy and safety. Both nurses and physicians had a precarious relationship with health authorities. Nurses felt that their employers and health authorities did not prioritize their health over patients' health, provided inaccurate and inconsistent vaccine information, and were mistrustful of pharmaceutical company motives. Like nurses, physicians were also skeptical of pharmaceutical company motives when it came to vaccination. Additionally, physicians also held doubts regarding vaccine efficacy and safety. Conclusions The relationship health care providers or their patients have with health authorities and other providers regarding vaccination serves as unsystematic clinical experiences that may bolster vaccine hesitancy. Providing accurate and tangible information to emphasize the safety and efficacy of vaccines to health care providers may help address their specific concerns that may ultimately increase vaccine uptake. [ABSTRACT FROM AUTHOR]

Background Parents' reluctance to vaccinate their children undermines the effectiveness of vaccination programmes in Western Europe. There is anecdotal evidence suggesting a connection between the rise of political populism and vaccine hesitancy. Methods This paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe and effective according to data from the Vaccine Confidence Project (2015). Results There is a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669). Conclusions Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts. It is necessary for public health scholars and actors to work to build trust with parents that are reluctant to vaccinate their children, but there are limits to this strategy. The more general popular distrust of elites and experts which informs vaccine hesitancy will be difficult to resolve unless its underlying causes—the political disenfranchisement and economic marginalisation of large parts of the Western European population—are also addressed. [ABSTRACT FROM AUTHOR]

Background Over the last years, research interest in vaccine hesitancy has increased. Studies usually focus on perceptions of parents and have largely neglected the group of health care providers. However, doctors' notions on vaccination have a major impact on the decision-making process of their patients. We were interested to understand the phenomenon of vaccine hesitancy among physicians, with a particular focus on the measles vaccine. Furthermore, we aimed to understand the underlying perceptions of measles that may be associated with vaccine hesitant decisions. Methods In order to get an in-depth view, semi-structured interviews with physicians were conducted. Doctors were eligible for the study if they articulated vaccine hesitant views and/or demonstrated vaccine hesitancy in their medical practice. Results We interviewed 12 physicians, of whom 11 had a medical practice with no contract with the Austrian social insurance ('Wahlarzt') and additional training in complementary and alternative medicine. We found perceptions of immunology, health and illness that were discordant with evidence-based medicine and closely related to alternative and complementary medicine. All participants argued for a delayed administration of the measles vaccine. We found a consistent inclination towards 'individual vaccination', which was explained as empowering parents and to strengthen their decision-making competencies. Most participants expressed doubts about the reliability of vaccine studies and were concerned with possible long-term effects. Conclusions Paying closer attention to doctors' concerns on vaccination might help to design target-oriented interventions to specifically strengthen vaccine confidence. [ABSTRACT FROM AUTHOR]

Background: Vaccine Hesitancy (VH) is considered by the WHO to be one of the ten threats of the 21st century. The Italian National Plan for Vaccine Prevention, as well as the European Action Plan, have among their objectives that of increasing the adherence to vaccinations both in general population and in categories at higher risk. It is precisely to these latter groups that the action of the Bologna Local Health Authority (LHA) has addressed targeted vaccination campaigns in recent years (e.g., DTP, HepB, PCV/PPV, RZV). Aim of our study was to investigate adherence to the proposed vaccination campaigns. Methods: An anonymous QR-code scanned survey was administered to adults during the COVID-19 vaccine campaign in February in Bologna, a city in Northern Italy. Results: A total of 2,321 participants were enrolled, 59% of whom were female. Among healthcare workers (n = 1,417), VH was 45.6% for Hib in 2020, 60.3% in 2019, and 68.3% in 2018; and 14.9% for HepB. Among people with chronic conditions (n = 149), 36.6% did not get the PCV/PPV vaccine. Among RZV vaccine recipients (n = 406), only 11.1% reported having been vaccinated. Women who were at least once pregnant in the last 5 years (n = 124), did not get the anti-pertussis vaccine in 41.9% of cases, and 71.8% of them refused the Hib vaccine. In general, the reasons most often given for missed vaccinations were ‘I did not inform myself enough about this specific vaccine’ (ranging from 16.0% for Hib for healthcare workers to 44.8% for RZV), ‘I am not informed about the vaccinations I am entitled to’ (27.3% for RZV, 31.8% for PCV/PPV), and ‘I do not find it useful’ (46.2% for Hib in healthcare workers). Conclusions: Our findings show that even in those who accept the COVID19 vaccine, VH is high for other vaccinations campaigns run by the Bologna LHA. Targeted awareness and designed catch-up actions are needed, especially regarding this group that does not totally stand in the ranks of the so-called ‘no vax’. Key messages: • Vaccine Hesitancy toward other vaccines remains high among those who accept the anti-COVID-19 vaccination. • A large number of hesitant respondents report either not being aware of the possibility of vaccination or not being adequately informed about the specific vaccine. [ABSTRACT FROM AUTHOR]

Vaccination against pertussis in pregnancy is the main strategy to prevent the disease in the first trimester of life of new-borns. Effective communication is essential to successfully engage pregnant women. The use of digital devices within the outpatient setting may be helpful to engage patients before and during the consultation. The aim of this study was to develop and test an e-health tool to assess vaccine hesitancy and to deliver tailored information and education interventions to raise awareness and promote vaccine acceptance. Methods: One-hundred-and-five participants were recruited in 4 ob-gyn clinics. Participants were invited to complete a self-administered psychometric questionnaire to assess vaccine hesitancy, disease beliefs and self-efficacy perception on health behaviours on a tablet. Participants were randomly allocated to three communication-format types providing equivalent content: 1)a single video simulating a patient-doctor conversation on the topic; 2)an interactive platform with five infographics videos; 3)a paper leaflet followed by a brief consultation with the physician. The intention to get vaccinated during pregnancy was assessed through a specific question before and after the intervention. Results: In the pre-intervention phase there was no difference observed between groups in terms of the variable "intention" to get vaccinated. After the intervention, participants of groups 1 and 3 showed a higher intention to get vaccinated than group 2 at the Kruskal-Wallis test (H(2)=6.008, p < 0.05). Post-intervention intention to vaccinate correlated with Individual SelfEfficacy (rs(105)=0.30, p < 0.001) and was inversely associated with vaccine hesitancy (rs(105)=0.34, p < 0.001). Conclusions: We implemented and assessed the impact of different communication strategies to promote vaccine uptake among pregnant women. Our results suggest comparable effect may be obtained using simulated versus live patient-physician communication. Key messages: The use of digital devices allows an effective and manageable communication about vaccination to pregnant women. In the present study, the implementation of digital forms of communication allowed a comparison with standard procedures of information towards vaccination, demonstrating their equivalence. [ABSTRACT FROM AUTHOR]

Background: Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants. Methods: A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328). Results: Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively. Conclusions: Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies. Key messages: • Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. • Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance. [ABSTRACT FROM AUTHOR]

Background Vaccination coverage is dropping in several countries, including Slovenia. More and more people hesitate or even reject vaccinations. As the influence of the internet grows, the question becomes how to communicate about vaccination to parents in order to prevent this drop in vaccination coverage among children. Methods For the first time in Europe, the Situational Theory of Publics (STOP) has been used in the field of vaccination to segment mothers to subpublics, and to prescribe a clearly defined form of communication for each of the segmented groups. In the survey, 1704 mothers participated who gave birth in 2014 and 2015 in Slovenia. Results The study showed that mothers react passively to information on vaccination no matter whether they come across it coincidentally or intentionally. Most often, they seek information about vaccination from friends or online. The more concerned they are about the safety of vaccines, the more they search for information about vaccination, and their communication is consequently more active. The mothers that problematize the safety of vaccines more, and are afraid of their adverse events tend to be in favour of alternative options. Conclusions Our research demonstrated that the STOP can be applied to the field of vaccination. There is a huge need for intensive professional communication about vaccination on the internet and social media. The improvement of the communicational competences of doctors and healthcare workers is essential to achieve better communication with parents and the media, and needs to be focused on mothers and pregnant women. [ABSTRACT FROM AUTHOR]

Background: Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors. Methods: A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine literacy. Chi square test and student’s t test were used to identify knowledge and attitudes associated with COVID-19 vaccine hesitancy. A p value equal or less than 0.05 was considered statistically significant. Results: Two hundred cancer patients were included with a mean age of 54.412.7 and a gender ratio equal to 0.5. Sixty-five percent reported that they would not receive the COVID-19 vaccine. Vaccine hesitancy was associated with lower interactive vaccine literacy score (1.60.8 vs 2.0, p = 0.002), skepticism regarding COVID-19 vaccine efficacy and safety (73.8% vs 38.5%, p < 0.001) and believing that health authorities will not be able to vaccinate the majority of the population (71,2% vs 55.7% p = 0.037). Conclusions: The proportion of COVID-19 vaccine hesitancy among cancer patients is high. Mass media campaigns for vaccine promotion should be enhanced. Physicians and health care workers play a key role in increasing acceptance and uptake of COVID-19 vaccine among high risk patients. Key messages: Majority of cancer patients were unwilling to receive the COVID-19 vaccine. Patient education about the benefits of vaccination against SARS-CoV-2 should be an integral part of oncology visits. [ABSTRACT FROM AUTHOR]

The authors convey their thoughts on vaccine hesitancy and the social responsibility of public health in Italy. Topics mentioned include vaccine hesitancy as one of the 10 global health threats for 2019 according to the World Health Organization (WHO), an updated National Immunization Prevention plan adopted in the country in 2017, and the WHO SAGE Working Group on Vaccine Hesitancy.

Background: With the availability of COVID-19 vaccines, vaccine hesitancy (VH) poses a great challenge to achieving herd immunity. Since young adults are usually asymptomatic, they may be less inclined to follow social distancing and mask-wearing guidelines. This study aimed at (i) quantifying VH among university students and (ii) investigating its determinants to identify barriers and predisposing factors to COVID-19 vaccination. Methods: Students physically attending Sapienza University of Rome during April 2021 were invited to take part in an online survey. The questionnaire explored sociodemographic variables, COVID-19 experience, attitude towards preventive measures, and COVID-19 vaccination. Hesitancy was measured as the complement to 10 of students’ intention to get vaccinated and was modeled through zero-inflated negative binomial regression analysis. Results: Overall, 1949 students were surveyed. Most were females (59.9%) and aged 23.8±4.9 years on average. A great proportion reported no (76.8%) or slight hesitancy (15.7%). At multivariable analysis, in the count part, being more scared for the pandemic (IRR=0.94, 95%CI: 0.89-0.98), rating COVID-19 as more severe (IRR=0.93, 95%CI: 0.89-0.98) and being Italian rather than non-Italian (IRR=0.68, 95%CI: 0.54- 0.85) were associated with lower VH, but no influence was found for age, sex, self-perceived risk of infection, and being a medical student. In the logit part, rating the vaccines as safe (b: 0.92, 95%CI: 0.75-1.10) or effective (b: 0.30, 95%CI: 0.14-0.45) decreased the likelihood of being hesitant. Conclusions: A few factors seemed to influence the intention to get vaccinated against COVID-19, including vaccine safety and effectiveness. Hence, attention should be given to planning effective communication about the vaccine profile in order to maintain and improve the public’s confidence. Also, partnerships should be established among the stakeholders to ensure coordinated information sharing and dissemination. Key messages: • Almost one-quarter of the surveyed students reported VH to some extent, and a few factors seemed to play a role in the vaccination decision-making process. • Among others, the perceived vaccine safety and effectiveness seemed to influence VH. Attention should be given to planning effective communication about the vaccines’ profile. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy (VH) remains worldwide a reason of concern. Most of the vaccination education strategies followed a ‘fact-based’ approach, based on the assumption that decision making is a rational process, without considering the influence of cognitive biases and heuristics. Our study aimed at identifying factors involved in the parents’ vaccination choice to inform and shape communication interventions. Methods: We conducted an online national survey among parents between November 2020 and April 2021. The questionnaire consisted of 59 items organised in 5 parts: personal information, cognitive biases, risk aversion, conspiracy mentality, and VH. Exploratory factor analysis was conducted to identify latent variables underlying the 19 items related to the 6 cognitive biases. Factors were categorised in quintiles and the corresponding pseudo-continuous variables used as predictors of the VH. Logistic regression model was applied to assess the association of the VH with factors, conspiracy mentality and risk propension. We adjusted for age, gender, economic status, and education levels. Results: The study included 939 parents, 764 women (81.4%), 69.8% had a degree or higher level of education. Considering cognitive biases, four factors explaining 54% of the total variance were identified and characterised as: fear of the side effects of vaccines (scepticism factor); carelessness of the risk and consequences of infections (denial factor); optimistic attitude (optimistic bias factor); preference for natural products (naturalness bias factor). All factors were positively associated with VH (p < 0.001) as were conspiracy mentality (p = 0.007) and risk propension (p = 0.002). Conclusions: This study confirmed the need to amplify the model used to analyse the VH considering cognitive biases as an important factor affecting the parents’ decision making. These results may be useful to design personalised communication interventions regarding vaccines and vaccination. Key messages: The model used to analyse the vaccine hesitancy needs to be extended including the evaluation of cognitive biases and heuristics. Communication interventions to promote vaccine acceptance should be tailored and personalized on the basis of the drivers of choice of the parents. [ABSTRACT FROM AUTHOR]

The WHO defines vaccine hesitancy (VH) as 'a delay in acceptance or refusal of vaccines despite the availability of vaccine services'. In spite of the models explaining VH and the tools used to address it, VH still represents a current problem and has been declared one of the top ten global health threats by WHO in 2019. This is mainly true for the adolescents who represents 25% of the global population. This systematic review aims to address the determinants of VH in this target population. Methods: PubMed, Web of Science and Scopus were searched to retrieve articles, published in English, assessing adolescents' attitudes and confidence towards vaccinations with any study design (qualitative or quantitative) from the inception until Dec 2020. A methodological quality assessment of the articles was performed based on the study designs. Results: Out of 14,704 articles, 20 studies were included in the qualitative analysis. Ten out of 20 studies were evaluated as of "good quality", while nine had "moderate quality" and only one had "poor quality". Factors associated to a positive attitude towards vaccination included knowledge of vaccine preventable diseases, the awareness of vaccines, their efficacy, safety and free of charge, higher education level and active involvement in decision-making. An association between VH and socio-economic conditions was also highlighted. [ABSTRACT FROM AUTHOR]

Background Rotavirus vaccine efficacy is well established. However, it is important to consistently demonstrate the positive impact of vaccination programmes in order to optimize uptake rates and combat vaccine hesitancy. Methods Routine data were used to examine rotavirus vaccine effectiveness in Ireland, including changes in age-specific crude incidence rates (CIRs), hospitalizations and hospital length of stay. National intussusception incidence was interrogated. Vaccination status of vaccine-eligible cases of rotavirus infection was determined. Results Nationally, a reduction in the CIR of rotavirus infection of 77.2% [95% confidence interval (CI) 57.8–88.5%, P <0.001] was observed post-inclusion of the rotavirus vaccine in the primary immunization schedule. A decrease in hospitalizations of 85.5% (95% CI 79.3–90.2%, P <0.001), 86.5% (95% CI 82.9–89.4%, P <0.001) and 78.5% (95% CI 74.7–81.9%, P <0.001) was observed in children aged <1, <2 and <5 years, respectively. Most hospitalizations occurred in infants too young to have been vaccinated. There was no significant difference in median length of stay for children hospitalized with rotavirus infection. Decreased CIRs and hospitalization rates in unvaccinated children aged between 2 and 5 years suggest community immunity. Vaccine non-protection was 0.13%. No increase in the national CIR of intussusception was observed. Conclusions Inclusion of the rotavirus vaccine in the Irish primary immunization schedule has resulted in a significant reduction in the burden of rotavirus infection. However, vaccine hesitancy remains a concern. With new vaccination programmes, risk of vaccine harms should be considered and mitigated in order to protect individuals and the integrity of the programme. [ABSTRACT FROM AUTHOR]

Background Vaccine hesitancy is an emerging phenomenon in European countries and leads to decreasing trends in infant vaccine coverage. The aim of this study was to analyze the level of confidence and correct awareness about immunizations, which are crucial for the success of vaccination programmes. Methods As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee's knowledge, beliefs and misconceptions, as well as their socioeconomic status, information sources about vaccines and confidence in the Italian National Healthcare Service. Results Only 9% of women completely believed to the efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on most of the themes. There was a significant difference in the level of knowledge considering educational level: women with a high educational level have less probability of obtaining a low knowledge score (odds ratio (OR) 0.43 [95% confidence interval (CI) 0.34–0.54]). The level of knowledge was also influenced by the sources of information: women who received information from their general practitioner (GP) and from institutional websites had a significantly lower chance of having misconceptions (OR 0.74 [95% CI 0.58–0.96]; OR 0.59 [95% CI 0.46–0.74]). Finally, the results underlined the influence of trust in healthcare professional information on the likelihood of having misconceptions (OR 0.49 [95% CI 0.27–0.89]). Conclusions The data suggest the efficacy of GPs and institutional websites as a source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence in vaccines. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic demanded quick exchanges between experts and institutions supporting governments to provide evidence-based information in response to the crisis. Initially, there was no regular cross-country forum in the field of population health. This paper describes the set-up and benefits of implementing such a forum. Methods A group of public health practitioners from academia, national public health institutes and ministries of health decided in April 2020 to meet bi-monthly to discuss a vast array of population health topics in a structured format called a Rapid Exchange Forum (REF). An ad-hoc mailing group was established to collect responses to questions brought forward in the forum from at least five countries within 24 h. This endeavour, which evolved as network of networks was awarded an EU grant in autumn 2020 and was called PHIRI (Population Health Information Research Infrastructure). Results Responses from up to 31 countries were compiled and shared immediately via the European Health Information Portal. This exchange was complemented by special REFs that focused on the advantages and disadvantages of vaccination, for example. By July 2023, 54 REFs had taken place with topics going beyond COVID-19. Conclusion The REF demonstrated its value for quick yet evidence-based cross-country exchange in times of crisis and was highly appreciated by countries and European Commission. It demonstrated its sustainability even after the acute crisis by expanding the topics covered and managing to continue exchange with the aim of capacity building and mutual learning, making it a true EU response and coordination mechanism. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is an increasing global health threat but much of the recent research has centred on the USA. European countries provide an interesting context due to increases in vaccine-preventable disease outbreaks as well as variability in vaccination laws. We investigated the spatiotemporal clustering of Measles, Mumps, and Rubella vaccination coverage in Germany, a country with a historic absence of compulsory vaccination laws. We also examined measles incidence in the context of the spatiotemporal clustering results. While we did not identify strong spatial patterns of geographic clustering in Germany, our results suggest a potential relationship between measles incidence and vaccination coverage cluster status. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy is the reluctance or refusal to be vaccinated. While it has been widely studied for various contagious diseases, there is still a lack of knowledge about this phenomenon for COVID-19, especially if health workers’ hesitancy is considered. Methods: An extensive review of the literature was conducted to identify the main determinants of vaccine hesitancy in health workers, as well as to find already validated surveys to evaluate the knowledge, attitudes and behaviors (KAB) of health workers towards vaccination, both in general and with specific regard to COVID-19. Building on the available information, a new survey was developed to assess the KAB of Italian health care workers towards COVID-19 vaccination after validation with a pilot study in a diverse sample of 30 Italian health workers. Results: A new survey was validated to assess the KAB of health workers towards COVID-19 vaccination in Italian health workers. The survey requires about 6 minutes to complete and is composed of 30 questions, investigating different domains: sociodemographic and professional characteristics (6); health status (2); attitudes (11); behaviors (6); knowledge (4). The survey will be administered to a representative sample of at least 385 Italian health workers through the web platform Survey-Monkey in the period June-September 2021. Preliminary results will be available by the end of October 2021. Conclusions: By analyzing KAB towards COVID-19 vaccination with a new tool, the magnitude and determinants of health worker’s COVID-19 vaccine hesitancy will be evaluated to understand how to improve health workers’ perception towards COVID-19 vaccination and, consequently, foster their positive influence on the general population. Key messages: We explore the knowledge, attitudes and behaviors towards COVID-19 vaccination in all categories of health workers operating on the Italian territory to understand the reasons of vaccine hesitancy. Understanding the determinants of COVID-19 vaccine hesitancy in Italian health workers is necessary given their influence on the perception of the general population in Italy. [ABSTRACT FROM AUTHOR]

Background: The pandemic has been accompanied by an infodemic, which includes false information that can lead to harmful consequences. Additionally, conspiracy theories have been linked to lower preventive behaviors. This work mainly aims to explore the skill in identifying COVID-19 fake news and the conspiracies beliefs. Methods: A cross-sectional study has been conducted amongst a convenience sample throughout Italy, using a ComputerAssisted Web Interview method (from 12 April 2021-ongoing). The survey included the Single-Item Literacy Screener (SILS), the eHealth Literacy Scale (eHEALS), a Fake News Score (FNS: percentage of misclassified news), a Conspiracy Score (CS: score from 1 to 5). Multivariable linear regressions were run (p < 0.05 as significant). Results: Up to date, participants were 1252. The median FNS and CS were: 25% (IQR=19-44) and 2.8 (IQR=2.2-3.4). For instance, 54% thought ibuprofen worsens COVID-19 symptoms and 50% agreed with ‘‘politicians usually do not tell us the motives for their decisions’’. The 17% had low health literacy (SILS) and 41% low eHealth literacy (eHEALS). COVID-19 vaccine hesitant people were 13%. The multivariable models identified many significant relationships. Low economic status and vaccine hesitancy were positively associated with FNS and CS. Higher education had a negative association with FNS and CS. Age was positively associated with FNS. Low health and eHealth literacy were positively associated with FNS. Low eHealth literacy had a negative association with CS. FNS was positively associated with CS. Conclusions: Associations between news misclassification, conspiracy beliefs and vaccine hesitancy might suggest shared determinants. EHealth literacy had a conflicting role. Attention should be paid to the mass media COVID-19 coverage as key information source for the general population. Public health campaigns should be planned to fight beliefs that hinder the reduction of transmission and might cause additional damages.Key messages: The median percentage of misclassified news was 25% (IQR=19-44) and the median Conspiracy Score was 2.8 (IQR=2.2-3.4). COVID-19 vaccine hesitant people were 13% and 41% had a low eHealth literacy. News misclassification, conspiracy beliefs and vaccine hesitancy were associated. EHealth literacy had conflicting associations with fake news and conspiracy beliefs. [ABSTRACT FROM AUTHOR]

Background Introduction of vaccines against COVID-19 has not encountered expected acceptance. The uptake of COVID-19 vaccines in Western Balkans countries is lagging behind the European Union average. The aim of our study was to assess the intention to get vaccinated against COVID-19 in the population of unvaccinated adult citizens of five Western Balkans countries, and to explore factors that influence the vaccination intention. Methods Cross-sectional study was conducted in the period from July to October 2021. The questionnaire was shared through online social media. Intention to get vaccinated against COVID-19 was measured by a single item assessing the likelihood of getting vaccinated on a 5-points Likert scale. Linear regressions were conducted with socio-demographic characteristics, presence of chronic diseases and attitudes towards COVID-19 vaccination as independent factors. Results The largest proportion of unvaccinated respondents willing to get vaccinated in the future was observed in Montenegro and Albania (40.4% in each country), while in the Serbian sample, the willingness to get vaccinated was the lowest (22.6%). Socio-demographic characteristics were not significantly associated with the intention to get vaccinated against COVID-19 in most of the countries. In Albania, Bosnia and Herzegovina, North Macedonia and Serbia the strongest determinant of COVID-19 vaccination intention was the higher sense of social responsibility. Conclusions Vaccination interventions and campaigns aiming to improve the COVID-19 vaccine uptake should be focussed on specific set of factors in each country, appealing to social responsibility as most prevalent determinant of vaccination intention in Western Balkans. [ABSTRACT FROM AUTHOR]

Background: During outbreaks of vaccine-preventable diseases, compulsory vaccination is sometimes discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. This study therefore assesses the effect of partial compulsory vaccination on the uptake of other voluntary vaccines. Method: A total of 297 (N) participants took part in an online experiment that simulated two sequential vaccination decisions using an incentivized behavioural vaccination game. The game framework bases on epidemiological, psychological and game-theoretical models of vaccination. Participants were randomized to the compulsory vaccination intervention (n = 144) or voluntary vaccination control group (n = 153), which determined the decision architecture of the first of two decisions. The critical second decision was voluntary for all participants. We also assessed the level of anger, vaccination attitude and perceived severity of the two diseases. Results: Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance). Conclusion: Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination. [ABSTRACT FROM AUTHOR]

Influenza is an important public health issue given its significant burden of disease. In Italy, the unsatisfactory coverage rate in people ≥65 years underlines the need to improve the current vaccination pathway. This study aims to define an integrated pathway across primary and secondary care, facilitated by a digital clinical decision support system (CDSS), to enhance vaccination coverage in people ≥65 years by actively recruiting patients in hospitals and administering vaccination. Moreover, the study seeks to gauge the potential epidemiological and economic impact of this approach. The methodology consisted of two main phases: definition of the integrated pathway and CDSS and estimation of the potential epidemiological and economic impact resulting from the implementation of the pathway in the whole Lazio region. Assuming an increase of influenza vaccination coverage from the current rate of 60% to 65% in ≥65 years old population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, avoided influenza- or pneumonia-related hospitalizations and avoided influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatient visits of up to 11.85%. Setting the vaccination coverage at 70%, the impact is doubled. Alongside offering a predictive estimate of the pathway's potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level. [ABSTRACT FROM AUTHOR]

Background: Covid-19 vaccines have been anticipated throughout the year 2020. These are envisaged by many as the way forward to beat the pandemic. However, vaccination hesitancy among the population is a public health concern. The aim was to explore the intend to take the Covid-19 vaccine among the adult residents of Malta. The vaccination roll-out in Malta started on 27th December 2020. Methods: An anonymous survey was distributed through social media platforms during February 2021, targeting adults residing in Malta. Socio-economic data along with the intention to take the Covid-19 vaccine was gathered. Quantitative and qualitative analyses were performed. Results: A total of 1,034 participants responded, with the majority showing intend to take the Covid-19 vaccine (75.44% CI95%:72.72-77.96). While 13.06% (CI95%:11.13-15.25) reported having already taken the vaccine. The majority of those not intending (n = 119) to take the vaccine were female (77.31% CI95%:68.95-83.96); between 30 to 39 years (42.02% CI95%:33.53-51.00), employed (76.47% CI95%:68.05-83.23) and with a post-graduate degree (36.97% CI95%:28.83-45.94). The commonest reasons for unintentional vaccine uptake were due to concern for its safety and long side effects as well as concerned if it is effective. Notably, 15.22% (CI95%:9.16- 24.06) of the females reporting not intending to take the vaccine were concerned about the effect of the vaccine on their pregnancy or else were planning to become pregnant. Conclusions: A high acceptance rate for the Covid-19 vaccine was observed among the Malta adults. However, an element of hesitancy was evident including among this study’s high socioeconomic status group. The unknown future and long-term effects of the vaccine appear to be the main contributors to hesitancy. Key messages: • Covid-19 vaccine is well accepted in Malta, potentially reflecting the population’s desire to protect themselves and their families. • Vaccine hesitancy is still evident even in the midst of the pandemic among high socio-economic group, reflecting the need for vaccine transparency. [ABSTRACT FROM AUTHOR]

Background: Italy was one of the earliest countries to experience a severe Covid-19 epidemic and vaccination is essential to controll it. The willingness to be vaccinated against Covid-19 was investigated by the Italian ongoing ;surveillance systems PASSI (18-69yy) and PASSI d’Argento (65+) with a Covid module added in August 2020. Methods: To measure the prevalence of hesitancy and refusal to receive the COVID-19 vaccine, we used a sample collected between August and December 2020, before starting the Covid-19 vaccination campaign. Sample was appropriately weighted to take into account the regional number and the composition by gender and age. Using a multinomial regression model, a specific analysis on elderly data were provided to examine the association between demographic and medical characteristics and Covid-19 attitudes. Results: Among adults, 67% answered to be likely accepting the vaccine (one half not hesitating at all and the other half very likely in any way); younger individuals, aged 18-34, are highly incline (76%). On older sample, 55% would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, the hesitancy group identified several risk factors in common with the refusal group, including not having gotten a flu vaccine during the previous flu season (hesitancy: RRR=2.0; 95% CI 1.4-2.9, refusal: RRR=12.1; 95%CI 7.6-19.37) and lower risk of having had a death from Covid-19 among family or friends (hesitancy: RRR=4.8; 95%CI 2.0-11.4, refusal: RRR=15.4; 95%CI 3.7-64.5). Hesitancy group has also lesser awareness and experience with the disease, a lower perception of being personally at risk and lower trust in the ability of health units to manage the pandemic situation. Conclusions: Results show the importance of establishing and maintaining ongoing contact among the preventive services, primary care providers and the population since trust is difficult to establish during an emergency. Key messages: • On of the most important finding for public health prevention efforts was the importance of influenza vaccine in predicting COVID. • Having an agile system that can monitor changing attitudes will be important to altering the messaging and identifying changes in the characteristics of those hesitant or unwilling to be vaccinated. [ABSTRACT FROM AUTHOR]

Background Given geographical disparities in vaccination coverage (VC) and the crucial role general practitioners (GPs) play in vaccination in France, we sought to: 1) determine the existence of geographical variations in GPs' perceptions of vaccines, their trust in information sources, and the frequency of their recommendations to patients by comparing data from southeast (SE), central-west (CW), northwest (NW), and the rest of France; and 2) identify individual and contextual factors associated with regional variations in GPs' recommendations. Methods This cross-sectional observational study in 2014 collected data from a panel of 2586 French GPs in private practice: 3 specific regional samples and a fourth sample for the rest of France. We calculated a composite score summarizing GPs' vaccine recommendation frequency for 6 vaccine situations and used a five-step hierarchical linear regression to study the score's links with practice location and individual and contextual factors. Results GPs' vaccine recommendation frequency score was highest in NW France and lowest in the SE. The low SE score was explained by GPs' greater doubts about vaccine utility and risks and lower trust in information sources. The high NW score was partially explained by greater adherence to guidelines by GPs there. The contextual factors studied did not explain regional differences. Conclusion The geographical variations in GPs' vaccination-related attitudes and practices suggest that vaccine hesitancy among GPs differs in prevalence between regions. These variations coincide with north/south trends in population VC. Intervention strategies to restore confidence in vaccines should target GPs and must be adapted to each regional context. [ABSTRACT FROM AUTHOR]

Background The French National Cancer Control Plan (NCCP) launched in 2014 set the objective to improve human papillomavirus (HPV) vaccination coverage (VC). The NCCP included a measure to integrate a VC indicator in the pay for performance (P4P) scheme for general practitioners (GPs), which was not implemented. The objective of the study was to analyse the reasons for non-implementation of this measure, using the health policy analysis framework. Methods The policy from proposal to non-implementation of the HPV VC indicator into the P4P scheme was analysed through the actors involved, the content of the measure, the contextual factors and the processes of policy-making. Results The actors were the Ministry of Health (MOH) and National Cancer Institute as policy-makers, the public health insurance as an indirect target, and GPs as direct targets. The content of the policy was not evidence-informed and was not included into the NCCP preparation report. The context included vaccine hesitancy and ethical concerns from GPs in opposition with MOH. The process involved a diversity of stakeholders with a complex governance and no strict monitoring of the measure. Conclusions Complex vaccination policy governance associated with a non-evidence-informed policy content and an unfavourable context may have been the reasons for the policy failure. [ABSTRACT FROM AUTHOR]

Background: The SARS-CoV-2-pandemic poses major demands for longterm care, which might have impacted the intention to quit the profession among managers of long-term care facilities. Methods: We used cross-sectional data of an online survey of German long-term care managers from outpatient and inpatient nursing and palliative care facilities surveyed in April 2020 (survey cycle one; n = 532) and between December 2020 and January 2021 (survey cycle two; n = 301). Results: Results from the multivariate logistic regression analysis, including all variables simultaneously, showed that the pandemic-specific demands [OR = 1.034; CI = 1.011-2.057] and the general demands [OR = 1.023; CI = 1.001-1.045] were significantly associated with the intention to quit the profession. This association was significantly stronger for general demands in survey cycle two compared with survey cycle one. The results highlight the pandemic’s immediate impact on long-term care. The interaction term between survey cycle and demands indicated that the association between general demands and the intention to quit the profession significantly rose between survey cycle one and two [OR = 1.036; CI = 1.000-1.072], whereas the association between pandemic specific demands and intention to quit the profession did not significantly vary by survey cycle [OR = 0.975; CI = 0.940-1.012]. Conclusions: In view of the increasing number of people in need of care and the already existing scarcity of specialized nursing staff, the results highlight the need for initiatives to ensure the provision of long-term care, also and especially in such times of crisis. Key messages: The intention to quit the profession among German managers of long-term care facilities has significantly increased during the SARS-CoV-2-pandemic. During the SARS-CoV-2-pandemic the perceived general demands as well as those directly related to the pandemic have increased significantly. [ABSTRACT FROM AUTHOR]

Background: High rates of vaccination are worldwide required to establish a herd immunity stopping the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide. Methods: A systematic literature search was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched, namely PubMed and Web of Science, on February 24th, 2021 using a set of developed keywords. Inclusion criteria included the study to be 1) conducted in English; 2) investigated attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; 3) utilized validated measurements techniques; 4) have the full text paper available and 5) be peer-reviewed prior to final publication. The Newcastle Ottawa (NOS) scale for cross sectional studies was used to assess the quality of the studies. Results: 73 studies were included in qualitative synthesis. Overall, vaccine acceptance rates ranged from 23.6% in Kuwait to 94.3% in Malaysia and Nepal. A variety of different factors contributed to increased hesitancy, some of which included having negative perception of vaccine efficacy, safety, convenience and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, less educated, with lower income, with no insurance, living in the rural area and self-identified as a racial/ethnic minority. Conclusions: Vaccine hesitancy rates against COVID-19 vaccine ranged widely among across different populations. Identifying the factors that interplay and result in high hesitancy rates among a population can allow formulating a directed intervention to increase their vaccination uptake rates. Key messages: • It is necessary to understand the factors that contribute to the COVID-19 vaccine hesitancy. • It is important to inform policy-makers and formulate direct intervention measures that will successfully handle the pandemic. [ABSTRACT FROM AUTHOR]

Background In 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective. Methods A combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association). Results Vaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines. Conclusions There are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession. [ABSTRACT FROM AUTHOR]

Background To encourage Covid-19 vaccination, France introduced during the Summer 2021 a 'Sanitary Pass', which morphed into a 'Vaccine Pass' in early 2022. While the sanitary pass led to an increase in Covid-19 vaccination rates, spatial heterogeneities in vaccination rates remained. To identify potential determinants of these heterogeneities and evaluate the French sanitary and vaccine passes' efficacies in reducing them, we used a data-driven approach on exhaustive nationwide data, gathering 141 socio-economic, political and geographic indicators. Methods We considered the association between vaccination rates and each indicator at different time points: before the sanitary pass announcement (week 2021-W27), before the sanitary pass came into force (week 2021-W31) and 1 month after (week 2021-W35) and the equivalent dates for the vaccine pass (weeks 2021-W49, 2022-W03 and 2022-W07). Results The indicators most associated with vaccination rates were the share of local income coming from unemployment benefits, overcrowded households rate, immigrants rate and vote for an 'anti-establishment' candidate at the 2017 Presidential election. These associations increase over time. Consequently, living in a district below the median of such indicator decreases the probability to be vaccinated by about 30% at the end of the studied period, and this probability gradually decreases by deciles of these indicators. Conclusions Our analysis reveals that factors related to poverty, immigration and trust in the government are strong determinants of vaccination rate, and that vaccination inequities tended to increase after the introduction of the French sanitary and vaccination passes. [ABSTRACT FROM AUTHOR]

In light of recent outbreaks of diseases such as measles in Europe, policymakers and public health practitioners are seeking strategies to address anti-vaccination attitudes and to increase immunization rates. Identifying effective strategies that will not further alienate vaccination sceptics raises challenges that go to the heart of relations between the state and society. Drawing on accounts of state–society relations, this article discusses how the problem of vaccination hesitancy might be explained from a political science perspective. Discourse-analytical approaches emphasize the importance of storylines, politics and social context in explaining a range of phenomena. Given the number and strength of prevailing discourses in groups with anti-vaccination sentiments, the literature on discourse coalitions can offer perspectives on the challenges that arise in designing strategies to address vaccine hesitancy. Paying closer attention to individual reasons why parents are vaccine hesitant might allow for designing strategies that are more suited to address concerns. However, given the pervasiveness of the discourses of anti-vaccination movements, challenges in reaching citizens who are sceptical of vaccines will remain. [ABSTRACT FROM AUTHOR]

The article offers news and updates related to the challenges and strategies for managing public health during conflicts. Topics discussed include the membership of the Ukrainian Public Health Association (UPHA) to the European Public Health Association (EUPHA), evidence linking alcohol to serious health risks, and the 18th European Public Health Conference in Helsinki, Finland from November 11-14, 2024.

Vaccination campaigns amid the coronavirus disease 2019 (COVID-19) pandemic have been extensively politicized in a number of countries. Controlling for a number of demographic, social and economic factors, we find a negative statistical relationship between the aggregate vote share of the populist-right wing Forum for Democracy and the vaccination rate against COVID-19 across Dutch municipalities. We also find a negative relationship between the proportion of individuals with reformed Protestant and Muslim religious beliefs. These relationships can possibly be related to religious worldviews or mistrust towards authority. These results show that the politicization of health behaviours can have detrimental effects on public health campaigns. [ABSTRACT FROM AUTHOR]

Introduction: Vaccinations have been touted as one of the ‘‘greatest public health achievements’’, but the rate of under-vaccination in child population is steadily declining, especially in low-income groups. Many studies show, that country-specific parental socio-demographic factors may influence on children’s immunization coverage. Aim: To assess which family socio-demographic factors influence parental vaccine hesitancy. Methods: A survey was conducted among 1195 parents of children under the age of 7y., between 2015-2017, mean age of 30.96.4y., of Bulgarian or other ethnic groups, living in Eastern Bulgaria. Questions about family socio-demographic factors, attitude, beliefs and fears were included. Results: The share of parents who state that they would not have vaccinated their children if the vaccination program was not compulsory is 20.9%. They are mainly in the age range 30- 39(42,4%;Spearman’s = 0,13;o<0,0001), with higher education(57.6%; Pearson’s r=- 0,13;o<0,001), of Bulgarian ethnicity (73,7%;Pearson’s r=-0,12;o<0,0001%), living in a larger town, mainly gathering information about vaccines from the Internet(29.9%), mass media(30%) and/or relatives and friends(25.5%). Even of compulsory vaccination programs, these parents tend to have children with missed or postponed vaccinations. Insufficient knowledge and/or shortcomings of the health system are the leading factors for parents with lower education and Roma ethnic group living in relatively smaller settlements, who do not to have a full-scale vaccination program of their children. Conclusions: Socio-demographic differences in parental attitudes towards compulsory vaccination require a differentiated approach. Preventive health care work is needed to overcome the growing anti-vaccine attitudes. Education and proper evidence-based proofs about vaccines and their benefits is needed for one types of a population group while increased knowledge and improved access to medical services for another population group. Key messages: A large-scale study, characterized as a representative to the country, about the parents’ attitudes towards immunization as a whole in the Republic of Bulgaria was carried out. Some socio-demographic factors that might have affected the readiness of parents to vaccinate their children have been analyzed. [ABSTRACT FROM AUTHOR]

Background: Over the latest decades, Europe has been facing the spreading of vaccine hesitancy. This growing phenomenon has resulted in decreasing vaccination coverage all over Europe, particularly in Italy for measles, mumps and rubella. In order to face up this problem, in 2017 Italy introduced compulsory vaccination against 10 different infectious diseases: diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenzae B (all included in the hexavalent vaccine), measles, mumps, rubella (included in the MMR vaccine) and chickenpox (from the 2017 cohort). The aim of this study was to evaluate vaccination coverages in 2019 in Abruzzo, an Italian Southern Region, after the introduction of compulsory vaccinations. Methods: In this study the following indicators were taken into account: vaccination coverages at 24 months of age (2017 cohort of birth), vaccination coverages at 36 month of age (2016 cohort), vaccination coverages at 5/6 years of age (2013 and 2014 cohorts) and vaccination coverages at 16 and 18 years of age (2001 and 2003 cohorts). Vaccination coverage rates were calculated as the number of vaccinated patients for each disease over the total number of patients born in the year considered. Results: At the end of 2019, the 2017 cohort reached 95% coverage for all vaccinations except for chickenpox (87.9%). Conversely, the 2016 cohort showed low rates for MMR and chickenpox, up to 90.8% and 52.1% respectively. Additionally, 2013 and 2014 teenager cohorts showed coverage rates lower than 95% for all the compulsory vaccinations. Conclusions: After two years of mandatory vaccination law in Italy, vaccination coverages have reached the 95% threshold only among patients of 24 months of age. Older cohorts still show inadequate vaccination coverages despite the introduction of mandatory vaccination law. Health services at regional level should develop policies and strategies aiming to improve vaccination coverages and to reach herd immunity. Key messages: After the introduction on mandatory vaccination, vaccination coverages reached the 95% threshold only among patients of 24 months of age. Health services should develop strategies aiming to improve vaccination coverages. [ABSTRACT FROM AUTHOR]

Background: With COVID-19 disrupting school life, there is a need to examine whether COVID-related changes in our schools may be creating or exacerbating inequalities among students. The aim of this poster is to examine potential differences associated to socioeconomic status (SES) both in different facets of school stress, and in the overall impact of COVID and specific school COVID-related measures. Methods: Sample consisted of 2,523 secondary school students (52.3% girls, M age = 13.78) from Spain who had participated in Project EASE from November 2020 to mid-January 2021, i.e. shortly after schools reopened for the new academic year. Using ANOVA and Chi-square analyses, differences associated to SES were examined in: (1) school stress, for which we used 3 subscales of the ASQ-S (school performance, future uncertainty, and school-leisure conflict), and (2) the perceived impact of COVID and specific school COVID-related measures (e.g. hygiene measures, social distancing, increased ICTs use) on stress levels. Results: We found no significant differences associated to SES in stress of school performance or stress of school-leisure conflict, but low SES was associated with higher stress due to future uncertainty. Regardless of SES, the majority of students reported that their levels of school stress had increased due to COVID-19. As for specific measures, the percentage of students that reported an increase in their level of stress due to the more frequent use of ICTs was higher among low-SES students, who also reported lower levels of stress associated to reduced contact with classmates due to COVID. Conclusions: Although most students reported an increase in school stress due to COVID-19, low-SES students experienced significantly higher stress due to future uncertainty. Potential differences in the role of specific school COVID-related measures would also deserve further examination. Key messages: Low-SES students experienced higher levels of stress due to future uncertainty. The majority of students, regardless of SES, reported increases in their stress levels due to COVID-19. [ABSTRACT FROM AUTHOR]

The digital age we currently live in is characterized by an overwhelming production of information by multiple users. This is particularly relevant in public health areas, where inaccurate information can be a threat to populations’ wellbeing. The internet became a field where anyone can produce non validated health information and spread rumors that can drive vaccine hesitancy, non compliance with public health measures and use of ineffective treatments, among other consequences highlighted by the COVID-19 pandemic. Public health professionals must be aware of such relevant concepts, the cognitive theories that support them and the strategies that can be used to monitor, identify, prevent and tackle the spread of health misinformation. However, such an approach should involve not only public health professionals but also journalists, data scientists, social marketeers and behavioural change experts involved in different organizations. Infodemic management is a recent area of research and practice that requires a comprehensive, multidisciplinary capacity building approach focusing behavioural change theories, digital technologies and social media, and community engagement strategies among others. This presentation will provide a brief introduction on main infodemic concepts and cognitive theories, show how infodemic management can overlap common epidemic management and highlight monitoring and social listening strategies and relevant interventions to prevent and tackle misinformation. [ABSTRACT FROM AUTHOR]

Although misinformation has been an issue in previous public health emergencies such as black plague or spanish flu, COVID-19 pandemic highlighted its importance. Nowadays, information about health is produced so quickly that it becomes complicated to manage it efficiently. Not only scientific evidence production increased exponentially, other sources of non-validated information also emerged through websites, blogs and social media. Public health professionals must be aware of such relevant concepts, the cognitive theories that support them and what the main threats to population’s health are - such as vaccine hesitancy, non compliance with public health measures and use of ineffective treatments. Due to their proximity to, and knowledge of communities, public health professionals are extremely important in infodemic management but should not neglect their online presence (particularly on social media) and the potential of partnerships with local organizations. The aim of this workshop is to provide an overview of public health services approach to infodemic management, including practical examples that can be applied by participants according to available resources. Infodemic management can be complex to handle at first, but particular areas should always be targeted in public health strategies. Social listening is a key step to understand communities’ concerns and identify sources of misinformation. It provides an efficient approach to detecting rumours and eases community engagement in the response process. As a way to prevent the spread of misinformation, communities should be ‘‘inoculated’’ with high-quality, engaging health information which can be co-produced with citizens to increase engagement and efficiency. On the other hand, misinformation and disinformation must be countered rapidly but carefully, through fact-checking teams and collaboration with community leaders and media platforms to ensure rapid dissemination. Capacity building and training for public health professionals in infodemic management is an emergent need, the foundations of which can be introduced in this short session. This workshop will be held in a skills building seminar format facilitated by two alumni of the WHO infodemic management training It consists of four specific parts. First, we will provide a brief introduction on main infodemic concepts and cognitive theories, which will be applied in a brief online game called ‘‘Bad News’’. Secondly, we will show how infodemic management can overlap common epidemic management, including focus in preparedness and monitoring. Then, we will showcase monitoring and social listening strategies and relevant interventions to prevent and tackle misinformation. Participants will be able to discuss examples of their own experiences or of those shared by panelists. Finally, we will provide useful links for more comprehensive training and practical tools that can be used at both local and national level. [ABSTRACT FROM AUTHOR]

Background: Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrantsensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic. Methods: We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out. Results: We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns [ABSTRACT FROM AUTHOR]

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. Methods We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. Results The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P  = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57–1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. Conclusion Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions. [ABSTRACT FROM AUTHOR]