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Background: The aim of this study was to explore the relationship between parental vaccine hesitancy and vaccine coverage for all recommended vaccines for children under five years residing in Statistical Areas Level 3 (SA3). SA3 groupings represent clustering groups of smaller areas, such as regional towns and cities or clusters of related suburbs, which share similar regional characteristics, administrative boundaries or labour markets, and generally have populations between 30,000 and 130,000 persons., Methods: We used parental vaccine hesitancy data from the VBAT (Vaccine Barrier Assessment Tool) study and vaccine coverage by postcode data from the Australian Immunisation Coverage Report 2020/21. Binary logistic regression analysis explored the association., Results: There were complete data for 1110 participants. We found lower vaccine concerns in parents residing in medium coverage (adjusted odds ratio (aOR) 0.36, 95 % confidence interval (CI): 0.22 to 0.59) and high coverage (aOR 0.37, 95 % CI: 0.22 to 0.60) SA3 areas compared to low coverage geographical areas., Conclusions: Developing effective policies to vaccinate children under five in low coverage areas will help reduce vaccine inequity in Australia. Future strategies to improve vaccine coverage should consider ways to address both access and acceptance barriers., Competing Interests: Declaration of competing interest JT is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GlaxoSmithKline) for investigator-led research. She does not receive any personal payments from Industry. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Vaccination is one of the most important public health interventions to combat infectious disease. However, vaccine hesitancy prevents us reaching the global target of vaccine uptake (e.g., 75 % of influenza vaccination in at-risk groups). This review summarises all interventions designed to reduce vaccine hesitancy and increase vaccine uptake for all types of vaccines offered to adults (≥18 years) since 2000, in the United Kingdom (UK)., Methods: PubMed, Cochrane Reviews, CINAHL EBSCO, and Scopus were searched (September 19, 2023). The PRISMA Checklist 2020 was used for quality checking. Data from randomised-controlled trials (RCTs) were analysed with a meta-analysis and narrative analysis. In all included studies, a narrative synthesis was undertaken to summarise, evaluate and characterisethe reported behaviour change interventions into four categories: organisational-level, public demand, provider-level, and multidimensional interventions. Findings are evaluated based on the MINDSPACE framework to understand the possible psychological mechanisms underpinning the interventions., Findings: A total of 9,842 articles were identified, 50 met the inclusion criteria. Interventions aimed to boost vaccine uptake or reduce hesitancy of influenza (50 %), COVID-19 (32 %), hepatitis B (6 %), and other vaccines. A meta-analysis was conducted for nine RCTs evaluating various interventions impact on vaccine uptake. The pooled effect was statistically significant (OR with 95 % CI = 1.23 [1.07 to 1.41]). Providing certain and understandableinformation and using a reminder system with personal messages or letters were the most frequently documented and effective interventions to enhance public demand (enhance information salience). Organisational level interventions intended to make vaccinations more accessible (e.g., providing vaccination at alternative places or times). Provider-oriented interventions encouraged healthcare workers to focus on reducing vaccine hesitancy or enhancing vaccine uptake., Interpretation: Among the main MINDSPACE techniques, enhancing the salience of vaccine information and priming vaccination by improving access were identified as the most applied and effective interventions in the UK., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Aysegul Humeyra Kafadar reports financial support was provided by Republic of Turkey Ministry of National Education. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper]., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States., Methods: Data from the 2019-2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months -17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5-11 years, and 12-17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points- before and after the authorization of the COVID-19 vaccine for each age group., Results: Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: -3.9, -0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5-11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12-17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups., Discussion: About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5-11 years and declined for children aged 6 months-4 years., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Vaccine hesitancy is a primary factor that influences vaccine uptake; however, no specific measurement tool to accurately assess vaccine hesitancy is available in China. This study aimed to develop a general vaccine hesitancy scale for childhood immunization., Methods: We adopted a three-phase process with nine steps to develop and finalize our scale. The scale framework and initial item pool were determined by a literature review. Expert consultation and cognitive interviews with parents were conducted to evaluate content validity. Questionnaire surveys involving parents of children aged <6 years were conducted to select items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to identify and validate the scale factor structure. The scale's reliability and validity were assessed using multiple indicators., Results: Of the initial 38 items, 21 were retained after expert consultation and cognitive interviews. In survey 1, the number of scale items decreased to 16 following item analysis and EFA. In survey 2, four items were added and EFA identified four factors. In survey 3, CFA confirmed the four-factor structure and the reliability indicators were satisfactory for the total scale. The level of vaccine hesitancy assessed by our scale was positively associated with vaccination refusal behavior and the Vaccine Hesitancy Scale score. The final scale comprised four dimensions (confidence, complacency, convenience, and calculation) with 17 items., Conclusions: We developed a validated and reliable measurement to assess vaccine hesitancy among parents of children, which promises to be suitable for wide use in China., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Strategies for reducing vaccine hesitancy and negative attitudes toward vaccination and measures to accurately assess them have been developed worldwide. The Vaccine Hesitancy Scale (VHS) and Vaccination Attitudes Examination Scale (VAX) are reliable and valid tools. This study evaluates the validity and reliability of the Korean versions of the Vaccine Hesitancy Scale (K-VHS) and Vaccination Attitudes Examination Scale (K-VAX)., Methods: We translated the VHS and VAX into Korean using forward and backward translations and tested their psychometric attributes. We collected data from a sample of 2,292 Koreans, recruited in June 2021 from a large online panel using quotas for age and gender. We used content validity, construct validity with confirmatory factor analysis, concurrent validity, and convergent validity to assess the validity of the scales, and tested their reliability with evaluations of internal consistency and stability., Results: The K-VHS and K-VAX showed good model fits in the validity tests, with seven items for one factor and 12 items for four factors, respectively. The internal consistency (Cronbach's alpha = 0.94 for the K-VHS, and 0.86 for the K-VAX) and stability (ICC = 0.86 for the K-VHS, and 0.88 for the K-VAX) of the measures indicated that they are reliable., Conclusions: Both tools are effective psychometric instruments for assessing vaccine hesitancy and vaccination attitudes in Korean adults. K-VHS and K-VAX would be useful for predicting vaccination behaviors in novel infectious disease contexts and communicating the evidence needed to develop related policies or programs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

IntroductionUptake of COVID-19 vaccination remains suboptimal in the United States and other settings. Though early reports indicated that a strong majority of people were interested in receiving the COVID-19 vaccine, the association between vaccine intention and uptake is not yet fully understood. Ourobjective was todescribe predictors of vaccine uptake, and estimate the sensitivity, specificity, and predictive values of self-reported COVID-19 vaccine status compared to a comprehensive statewide COVID-19 vaccine registry.MethodsA cohort of California residents that received a molecular test for SARS-CoV-2 infection during 24 February-5 December 2021 were enrolled in a telephone-administered survey. Survey participants were matched with records in a statewide immunization registry. Cox proportional hazards model were used to compare time to vaccination among those unvaccinated at survey enrollment by self-reported COVID-19 vaccination intention.ResultsAmong 864 participants who were unvaccinated at the time of interview, 272 (31%) had documentation of receipt of COVID-19 vaccination at a later date; including 194/423 (45.9%) who had initially reported being willing to receive vaccination, 41/185 (22.2%) who reported being unsure about vaccination, and 37/278 (13.3%) who reported unwillingness to receive vaccination.Adjusted hazard ratios (aHRs) for registry-confirmed COVID-19 vaccination were 0.49 (95% confidence interval: 0.32-0.76) and 0.21 (0.12-0.36) for participants expressing uncertainty and unwillingness to receive vaccination, respectively, as compared with participants who reported being willing to receive vaccination. Time to vaccination was shorter among participants from higher-income households (aHR = 3.30 [2.02-5.39]) and who reported co-morbidities or immunocompromising conditions (aHR = 1.54 [1.01-2.36]).Sensitivity of self-reported COVID-19 vaccination status was 82% (80-85%) overall, and 98% (97-99%) among those referencing vaccination records; specificity was 87% (86-89%).ConclusionWillingness to receive COVID-19 vaccination was an imperfect predictor of real-world vaccine uptake. Improved messaging about COVID-19 vaccination regardless of previous SARS-CoV-2 infection status may help improve uptake.

Background and Objectives: Vaccine hesitancy (VH) has been increasingly recognized as a global threat to public health. Yet, limited research exists exploring healthcare providers' experience of this phenomenon. Our study aims to understand community pharmacists' attitudes towards, and experiences with, influenza VH, and explore factors impacting their engagement with patients on the influenza vaccine., Methods: A semi-structured interview guide was developed, and interviews were conducted to saturation with community pharmacists practicing in Ontario, Canada. Interview data was transcribed verbatim and analyzed using a thematic content analysis framework. The analysis yielded 110 unique codes, which were merged into five major themes and 15 sub-themes., Results: A total of 22 pharmacists were interviewed to achieve saturation. Most pharmacists were authorized to administer injections (n = 20, 90.9%) and practiced for >20 years (n = 16, 72.7%). Pharmacists' engagement with patients on the influenza vaccine was found to be modulated by a complex and mutually reinforcing constellation of attitudes and behaviours which include: a binary (pro-vaccine or anti-vaccine) perception of patient vaccination decisions; a conflation of those expressing hesitancy with those who are anti-vaccine; and a passive approach to patient engagement, wherein patients were found to be the primary initiators of vaccine conversations. Although pharmacists recognized the importance of educating patients and addressing their vaccine-related concerns, barriers such as limited time, inadequate staffing, and poor remuneration were found to restrict optimal patient engagement on influenza vaccinations., Conclusion: While pharmacists hold the potential to effectively address influenza VH within their communities, future interventions must aim to break the loop of passive patient engagement and enable proactive pharmacist-patient interactions on influenza vaccinations in this setting., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Houle and Waite have received educational grants from Merck and Sanofi, and Dr. Houle has received support for a graduate student trainee from Valneva, Canada., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Background: Vaccine hesitancy is a complex behaviour which involves various degrees of indecision about specific vaccines or vaccination uptake. Access to antenatal care had been associated with positive vaccine behavior., Objective: To determine the prevalence of vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers and the associated socio-demographic factors., Methods: A cross-sectional study was conducted among 1081 women who received antenatal care at a teaching hospital in Kuala Lumpur. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines (PACV) Survey in both English and validated Malay versions. The sociodemographic data of the mothers and their partners, source of vaccine information and reasons for hesitancy were analysed., Results: Eighty-six (8.0%) pregnant mothers were vaccine hesitant. Ethnicity, religion, number of children, educational level and employment status were significantly associated with vaccine hesitancy. Multivariable analysis showed that a low level of education was the most significant risk factor (p < 0.001), followed by religion (p = 0.03). Health professionals was the main source of information about vaccine. The non-vaccine hesitant women were more likely to seek information from health professionals, and health books and magazine. Fear of adverse side effects of vaccines was the predominant concern for all participants (58%) whilst fear of vaccination pain, preference for alternative medicine and lack of trust in the pharmaceutical industry were significant reasons given by the vaccine hesitant group. Partners' ethnicity, a low educational level and a low income were significantly associated with vaccine hesitancy amongst pregnant mothers., Conclusion: Prevalence of vaccine hesitancy amongst urban Malaysian pregnant women was relatively low. Muslim mothers are less likely to be vaccine hesitant. Educational level of mothers and their partners are the common determinant of vaccine hesitancy amongst antenatal mothers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

• We provide quantitative evidence on the association between vaccine hesitancy and adverse vaccination behaviors. • We explore the association between vaccine hesitancy and adverse vaccination behaviors within various population characteristics. • The association between vaccine hesitancy and vaccination behaviors may be influenced by geographic regions, age, and health status. • Parents of children without high-risk health conditions may exhibit higher rates of vaccine hesitancy. Vaccination is crucial for prevention of infectious diseases, and identification of the impact of vaccine hesitancy on vaccination programs is crucial for early intervention and formulation of policies to alleviate vaccine hesitancy. The aim of this systematic review was to explore the relationship between vaccine hesitancy and negative vaccination behavior globally. We searched for observational studies in various databases. We conducted a meta-analysis using pooled odds ratios (OR) and 95 % confidence intervals (CI), performed meta regression and subgroup analysis to explore the role factors such as location and individual characteristics on the association between vaccine hesitancy and vaccination behavior. A total of 46 articles were included in systematic analysis and 34 articles were included in the meta-analysis. The systematic analysis comprised 162,601 samples, whereas the meta-analysis included 147,554 samples. The meta-analysis showed that a higher rate of vaccine hesitancy was associated with an increased likelihood of adverse vaccination behaviors (all adverse behaviors: OR = 1.50, 95 % CI, 1.33–1.70, P < 0.001; unvaccinated: OR = 1.48, 95 % CI, 1.29–1.70, P < 0.001; vaccine delay: OR = 2.61, 95 % CI, 1.97–3.44, P < 0.001). The meta-regression results indicated that the heterogeneity observed was mainly from sample selection methods, age of vaccinees and the health status of participants. The results showed that parents of minor vaccinees or without high-risk health status had a higher association between vaccine hesitancy and vaccine uptake compared with populations exposed to higher health risks or adult vaccinees. The findings provide evidence on the association between vaccine hesitancy and adverse vaccination behaviors. The results showed that these population-specific factors should be considered in future research, and during formulation of interventions and implementation of policies to improve vaccination uptake. [ABSTRACT FROM AUTHOR]

Background: In many regions of the world, vaccine hesitancy has become an important concern to public health. A key part of any effective solution to it is to gain an in-depth understanding of the problem: its scope, who holds hesitant views and for which reasons., Methods: We adapt the original 10-item Vaccine Hesitancy Scale (VHS), which targets parental attitudes, to a more generic version that captures general attitudes to vaccination. We use this adapted VHS in a sample of 1402 British citizens, selected from a large online panel (N > 1,000,000) based on quota for age, gender, educational attainment and region (response rate 43%). The existence of VHS subscales is evaluated via exploratory and confirmatory factor analysis. We describe the extent of vaccine hesitancy in the sample, and use simple and multiple regression analysis to examine associations between respondent characteristics and vaccine hesitancy., Results: Despite ambiguities in defining hesitancy, we found that a substantial part of our sample held hesitant views about vaccination, particularly for those items reflecting aversion to risks of side effects. Four percent responded in a hesitant way to all ten items and ninety to at least one of the ten items. In line with recent studies in other populations, we identified two subscales within the VHS: lack of confidence in the need for vaccines and aversion to the risk of side effects. We found significant associations between hesitancy and various respondent characteristics but the predictive power of these associations remained limited., Conclusion: Our study suggests that whereas a substantial percentage of the British population is vaccine hesitant, these views are not clustered in typical demographic features. The small but important adaptation of the VHS to target general attitudes seems to result in highly similar psychometric characteristics as the original scale that exclusively targets parents. We provide suggestions for further validation of the VHS., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Health care worker vaccine uptake rates are below official targets, and studies demonstrate some are vaccine hesitant. We assessed self-vaccination behavior, vaccine hesitancy (VH), and associated factors in a representative sample of nurses., Methods: Cross-sectional questionnaire survey in 2017-18 in southeastern France (5 million inhabitants): community nurses were randomly selected from a list provided by the Inter-Regional Nurses' Council (stratified by gender and district of practice) and interviewed by telephone. Because no such list exists for hospital nurses (74% of all nurses in southeastern France), we randomly selected hospitals, taking their size into account and stratifying by district. Hospital nurses practicing in medicine, surgery, obstetrics, and gynecology departments and present at the time of the survey were included and interviewed face-to face. We measured VH according to the WHO definition (refusal, delay, or acceptance with doubts about at least one vaccine). Interviewers administered the questionnaires. We used multivariable logistic regression to analyze potential associations between VH, vaccine risk perceptions and trust in health authorities., Results: Interviews were completed with 1539 nurses (response rate: 85%). Self-reported vaccine coverage ranged from 27% (seasonal influenza vaccine, recommended, 2016/17 season) to 96% (Bacillus Calmette-Guérin vaccine, mandatory). The VH prevalence rate was 44% (95% confidence interval: 38.7-48.4) and most often concerned seasonal influenza or A(H1N1) vaccines (54%) and the hepatitis B vaccine (18%). VH was significantly more frequent among nurses with low trust in health authorities or high vaccine risk perceptions., Conclusion: Nurses in southeastern France have low levels of self-vaccination acceptance for most recommended vaccines. In addition, they have a high VH prevalence focused on the same vaccines as among the general population. These are important findings given that nurses are in regular contact with patients vulnerable to vaccine-preventable diseases and their VH could negatively influence patients' vaccination acceptance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019. Published by Elsevier Ltd.)

First year medical students at an allopathic medical school regional campus were asked to complete a 10-question survey at both the beginning and the conclusion of a required course on immunology, hematology and oncology. The survey was designed to solicit student attitudes about vaccination and the students' level of comfort with and exposure to vaccine hesitant patients. Surveys were administered to five consecutive classes from 2013 to 2017. Total response rate for completion of both surveys was 58.0% (178/307). Pre- and post-course surveys were administered to assess whether curricular experiences altered the students' perceptions about vaccinations and their ability to counsel vaccine hesitant patients. Curricular elements were presented in several different formats aimed at increasing student knowledge about vaccinations and student capacity to work with vaccine hesitant patients and families (problem-based learning, didactic lecture and interactive panel discussion). In the pre-survey, the majority of students reported having already encountered people who decline vaccinations (78.8%). Additionally, in the pre-survey the majority of medical students expressed strong support for vaccination (99.6% agreed with the statement that Vaccinations are a great public health accomplishment) and strong disagreement with both of the assertions that childhood vaccines cause autism and vaccine preservatives cause adverse health effects. In response to questions about comfort level while talking with patients about vaccine choices, baseline responses demonstrated a moderately high level of comfort. Post-course surveys revealed a statistically significant increase in student-rated comfort level in talking with patients about vaccine choices (pre-survey 79.2% report comfort versus post 97.8%; p < 0.001). Though this study is limited to student self-reporting, survey responses suggest that targeted curricular elements can improve medical student confidence in counseling patients about vaccinations. Future curricular elements designed to directly observe student performance could provide verification of counseling skill acquisition., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

On the 4 February 2019, the Western Cape Department of Health's Facebook page announced the implementation of a school-based vaccination campaign aimed to administer the first doses of human papillomavirus (HPV) vaccine in public schools to Grade 4 girls who are nine years old. This announcement was met with a flurry of social media responses posted on the campaign's Facebook page. This study identifies determinants of vaccine hesitancy amongst responses provided by social media users to this post. On 8 March 2019, we conducted a qualitative study including all 157 comments to the Facebook post. The post had 659 'emotion' reactions: 574 "likes", 62 "loves", 21 "angry faces", 2 "laughs", 2 "wows" and 1 "sad face". An overwhelming majority (636/659 i.e. 97%) of reactions were favourable to the HPV vaccination campaign. Out of the 157 comments, we judged 52 (33%) of them to be 'hesitant', suggesting that people with negative reactions though few in number, were more likely to be vocal deniers. Concern around the safety of HPV vaccines including effects on reproductive health was the most common theme identified. Other emerging themes included: risk of cervical cancer perceived as being low, issues around consent, concerns that girls are being used for research, questionable vaccine effectiveness, use of the school-based strategy for the campaign, risk-benefits calculations of HPV vaccination and constraints such as stock-outs. Knowing someone who had been affected or being at risk of cervical cancer, having knowledge about the causes of cervical cancer, confidence in the effectiveness and safety of the vaccine, knowing the vaccine was being used in high income settings, and having strong recommendations from the World Health Organisation and key actors seemed to increase the willingness to accept the vaccine. The magnitude and causes of HPV vaccine hesitancy need to be investigated to ensure the success of this programme., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The growth of Web 2.0 has been particularly impactful in shaping information assessment in decision-making with regards to vaccination. The aim of the present study was to explore how attitudes and beliefs about influenza vaccination are exchanged in Web 2.0 through an analysis of user comment threads in response to related news reports on the Canadian Broadcasting Corporation national news website (average of 5.8 million unique visitors per month). User comments (n = 2042) were extracted using a Google Chrome data mining extension, from 33 articles reporting on the seasonal influenza vaccine between September 2015 and October 2016. User comments were analyzed using thematic discourse analysis to identify themes within the data, and also identify how information is exchanged, including identifying the rhetorical devices and tactics used. Mostly unrelated to article content, user comments were extremely polarized with only those with strong positions at either end of the vaccination spectrum (for or against) engaging actively in online debates. Observed exchanges, and the use of rhetorical devices and tactics employed by users are identified as furthering or reinforcing polarization. In addition to exchanging information, forums served as 'echo chambers' where individuals connect with likeminded users and collect additional information to reinforce pre-existing beliefs, rather than encouraging the enrichment of user knowledge. Our data lead us to question existing calls for public health engagement in such online forums, as doing so may actually reduce the intention to vaccinate among individuals against vaccination. Rather, we identify a greater need to observe online platforms to better understand the social mechanisms that may contribute to, or reinforce, attitudes and beliefs related to influenza vaccine refusal. Further research may also explore the effect that such dialogue has on the attitudes and beliefs of passively observing individuals who have yet to decide whether to receive the flu vaccine., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Vaccine hesitancy (VH) has emerged as a factor in vaccine delay and refusal yet the measurement of the constructs within vaccine hesitancy remains a challenge. Outstanding questions include; should VH be measured as an attitude or a behavior? What is the role of key constructs including confidence, complacency, and convenience? What is the role of trust? Should measures be general or vaccine specific? Furthermore, much of the research has centered on parental acceptance of vaccines for their children., Methods: In March of 2015, we contracted with the GfK Group to conduct a nationally representative survey with 819 African American and 838 White, US born adults. Measures include general vaccine hesitancy and confidence, trust, and influenza vaccine specific measures of hesitancy, confidence and trust., Results: Factor analysis yielded a bi-factor structure for both general vaccine hesitancy and flu vaccine specific hesitancy. Greater hesitancy, both in general and specific to the flu vaccine, was associated with lower vaccine uptake. In the flu vaccine specific model, greater confidence was associated with higher vaccine uptake. Trust remained distinct from vaccine confidence in both the general and flu vaccine specific models., Conclusions: Clearly, there is value in the utilization of general vaccine hesitancy and confidence measures, as well as vaccine specific measures. Trust continues to provide additional insights apart of vaccine confidence and remains an important factor for inclusion in future research. Our set of measures can be tested and validated with other populations and applied to other vaccines for adults and children., (Copyright © 2019. Published by Elsevier Ltd.)

Background: The aims of the study are to evaluate attitudes about childhood vaccines and vaccine refusal or delay among parents and to assess the role played by the variables mapped as potential determinants to suggest strategies that could improve childhood vaccination rates., Methods: The cross-sectional study was intended for parents of kindergarteners. Parental attitudes were measured using the Parent Attitudes about Childhood Vaccines (PACV) survey, to screen for Vaccine Hesitancy (VH). In addition, selected factors have been grouped in three categories (contextual, individual and group and vaccine/vaccination-specific influences), and were explored as potential determinant of VH and vaccination refusal or delay., Results: 7.7% of subjects were defined as VH parents (VHPs) through PACV score, while 24.6% reported having refused or delayed at least one dose of vaccine for their child. VH was more common in those parents that decided not to vaccinate their child after having received information from mass-media, in those who did not agree with mandatory vaccinations, and in those who agreed with political leaders who oppose to vaccination. Vaccine refusing/delaying parents were more frequently those who agreed that infant vaccinations are primarily an economic business of pharmaceutical companies, and who disagreed that access to the kindergarten should only be allowed to children who had been vaccinated., Conclusion: The findings of the present study emphasize the importance of PACV as a tool to screen VHPs. Furthermore, results highlight important potential determinants of VH, such as communication and media environment, and attitudes about prevention. Health care providers could act as key components to improve the public trust to scientific and epidemiological evidence., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Growing vaccination hesitancy is well-document among humans. However, we know very little about vaccination hesitancy for pets as well as whether the two phenomena are interconnected. Moreover, support for pet vaccination requirements also remain underassessed. We fielded a large, national survey (N = 3,958) on August 18 and August 19, 2023, to assess U.S. public opinion about the vaccination status of dogs (rabies, canine parvovirus, canine distemper, canine influenza, and Lyme disease) and cats (rabies, feline panleukopenia (parvo), feline herpesvirus-1, feline chlamydia, and feline Bordetella) in the United States. We also queried respondents about their support for vaccination requirements for the 10 diseases. We find that the vast majority of cats and dogs are vaccinated. However, a substantial minority of pets is not, particularly for cats and for non-core vaccines. We find that attitudinal measures of human and pet vaccine hesitancy are closely related to each other. Moreover, they are strong predictors of vaccine behavior. Measures of vaccine hesitancy are also strong predictors of support for vaccination mandates. Common measures used to assess human vaccine hesitancy showed inconsistent effects. However, pet vaccinations appear to be less politically polarizing. The high correlation between pet and human measures raises the stake for public health efforts to improve attitudes about vaccines and vaccination rates across the board. Strong support for vaccination requirements should encourage policymakers to explore policy change. Moreover, veterinarians and their associations should consider expanding the number of core vaccinations. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P < 0.001); by 2015, the pattern was inverted with higher coverage among poor children (SII = -6.0; P = 0.01). Vertical immunization programs in the 1980s and creation of the National Health Services in 1980 eliminated the social gradient that had been present up to the 1980s, to reach near universal coverage. The recent decline in coverage is likely associated with the growing complexity of the vaccination schedule and underfunding of the health sector. In addition, the faster decline observed among children from wealthy families is probably due to vaccine hesitancy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In scholarly and popular discussions of vaccine hesitancy, authors have repeatedly referred to different "types" of vaccine hesitant individuals; however, almost all modern research on vaccine hesitancy utilizes variable-centered approaches to identify the relation of variables rather than a person-centered approach to identify subpopulations, which suggests that a discrepancy exists between conceptual discussions and empirical research on vaccine hesitancy. For this reason, the current article conducts a latent profile analysis (LPA) on the dimensions of a well-supported vaccine hesitancy measure, which assess hesitancy towards vaccines in general. We also assess the relations of the resultant profiles (e.g., subpopulations) with relevant self-reported outcomes and correlates, wherein most of our outcomes are associated with COVID-19 and flu vaccines. Our LPA results support the existence of eight vaccine hesitancy profiles. The profile with the most unfavorable vaccination outcomes (e.g., willingness, receipt, and word-of-mouth) was associated with greater perceptions that vaccines cause health risks and unneeded when healthy; the profile with the most favorable vaccination outcomes was associated with low levels of all vaccine hesitancy dimensions. The other profiles produced a clear gradient between these two extremes. The profiles also differed regarding their standing on correlates, but the clearest difference was their relation with political orientation. Profiles with more unfavorable vaccination outcomes were associated with conservatism, whereas profiles with more favorable vaccinations outcomes were associated with liberalism. These results provide a new perspective for current understandings of vaccine hesitancy and open several avenues for future research. [ABSTRACT FROM AUTHOR]

Although vaccination uptake is high in most countries, pockets of sub-optimal coverage remain posing a threat to individual and population immunity. Increasingly, the term 'vaccine hesitancy' is being used by experts and commentators to explain sub-optimal vaccination coverage. We contend that using this term to explain all partial or non-immunisation risks generating solutions that are a poor match for the problem in a particular community or population. We propose more precision in the term 'vaccine hesitancy' is needed particularly since much under-vaccination arises from factors related to access or pragmatics. Only with clear terminology can we begin to understand where the problem lies, measure it accurately and develop appropriate interventions. This will ensure that our interventions have the best chance of success to make vaccines available to those who want them and in helping those who are uncertain about their vaccination decision., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: In 2013, the annual influenza immunisation programme in England was extended to children to reduce the burden of influenza, but uptake was sub-optimal at 53.2%., Aim: To explore the reasons some parents decided not to vaccinate their child against influenza as part of the pilot programme offered in schools., Methods: Cross-sectional qualitative study conducted between February and July 2015. 913 parents whose children were not vaccinated against influenza in the school pilots in West Yorkshire and Greater Manchester, England, were asked to comment on their reasons for non-vaccination and invited to take part in a semi-structured interview. 138 parents returned response forms, of which 38 were eligible and interested in participating and 25 were interviewed. Interview transcripts were coded by theme in NVivo., Results: A third of parents who returned response forms had either vaccinated their child elsewhere, intended to have them vaccinated, or had not vaccinated them due to medical reasons (valid or perceived). Most interviewees were not convinced of the need to vaccinate their child against influenza. Parents expressed concerns about influenza vaccine effectiveness and vaccine side effects. Several parents interviewed declined the vaccine for faith reasons due to the presence of porcine gelatine in the vaccine., Conclusions: To significantly decrease the burden of influenza in England, influenza vaccination coverage in children needs to be >60%. Hence, it is important to understand the reasons why parents are not vaccinating their children, and to tailor the communication and immunisation programme accordingly. Our finding that a third of parents, who did not consent to their child being vaccinated as part of the school programme, had actually vaccinated their child elsewhere, intended to have their child vaccinated, or had not vaccinated them due to medical reasons, illustrates the importance of including additional questions or data sources when investigating under-vaccination., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Vaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent's decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents., Methods: We created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine., Results: Pre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1-5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention., Conclusion: Our innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In order to gather a global picture of vaccine hesitancy and whether/how it is changing, an analysis was undertaken to review three years of data available as of June 2017 from the WHO/UNICEF Joint Report Form (JRF) to determine the reported rate of vaccine hesitancy across the globe, the cited reasons for hesitancy, if these varied by country income level and/or by WHO region and whether these reasons were based upon an assessment. The reported reasons were classified using the Strategic Advisory Group of Experts (SAGE) on Immunization matrix of hesitancy determinants (www.who.int/immunization/sage/meetings/2014/october/SAGE&#95;working&#95;group&#95;revised&#95;report&#95;vaccine&#95;hesitancy.pdf). Hesitancy was common, reported by >90% of countries. The list of cited reasons was long and covered 22 of 23 WHO determinants matrix categories. Even the most frequently cited category, risk- benefit (scientific evidence e.g. vaccine safety concerns), accounted for less than one quarter of all reasons cited. The reasons varied by country income level, by WHO region and over time and within a country. Thus based upon this JRF data, across the globe countries appear to understand the SAGE vaccine hesitancy definition and use it to report reasons for hesitancy. However, the rigour of the cited reasons could be improved as only just over 1/3 of countries reported that their reasons were assessment based, the rest were opinion based. With respect to any assessment in the previous five years, upper middle income countries were the least likely to have done an assessment. These analyses provided some of the evidence for the 2017 Assessment Report of the Global Vaccine Action Plan recommendation that each country develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning (www.who.int/immunization/sage/meetings/2017/october/1&#95;GVAP&#95;Assessment&#95;report&#95;web&#95;version.pdf)., (Copyright © 2018. Published by Elsevier Ltd.)

In Italy, in 2016, we conducted a cross-sectional survey to estimate vaccine hesitancy and investigate its determinants among parents of children aged 16-36 months. Data on parental attitudes and beliefs about vaccinations were collected through a questionnaire administered online or self-administered at pediatricians' offices and nurseries. Parents were classified as pro-vaccine, vaccine-hesitant or anti-vaccine, according to self-reported tetanus and measles vaccination status of their child. Multivariable logistic regression was used to investigate factors associated with hesitancy. A total of 3130 questionnaires were analysed: 83.7% of parents were pro-vaccine, 15.6% vaccine-hesitant and 0.7% anti-vaccine. Safety concerns are the main reported reason for refusing (38.1%) or interrupting (42.4%) vaccination. Anti-vaccine and hesitant parents are significantly more afraid than pro-vaccine parents of short-term (85.7 and 79.7% vs 60.4%) and long-term (95.2 and 72.3% vs 43.7%) vaccine adverse reactions. Most pro-vaccine and hesitant parents agree about the benefits of vaccinations. Family pediatricians are considered a reliable source of information by most pro-vaccine and hesitant parents (96.9 and 83.3% respectively), against 45% of anti-vaccine parents. The main factors associated with hesitancy were found to be: not having received from a paediatrician a recommendation to fully vaccinate their child [adjusted odds ratio (AOR): 3.21, 95% CI: 2.14-4.79], having received discordant opinions on vaccinations (AOR: 1.64, 95% CI: 1.11-2.43), having met parents of children who experienced serious adverse reactions (AOR: 1.49, 95% CI: 1.03-2.15), and mainly using non-traditional medical treatments (AOR: 2.05, 95% CI: 1.31-3.19). Vaccine safety is perceived as a concern by all parents, although more so by hesitant and anti-vaccine parents. Similarly to pro-vaccine parents, hesitant parents consider vaccination an important prevention tool and trust their family pediatricians, suggesting that they could benefit from appropriate communication interventions. Training health professionals and providing homogenous information about vaccinations, in line with national recommendations, are crucial for responding to their concerns., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

• COVID-19 vaccine hesitancy was heterogeneous both in terms of time and magnitude. • Following COVID-19 news, trust levels, risk preferences, and vaccine confidence predicted intention reversals. • Lowering the cost of following the news for the population may raise vaccine uptake. This paper investigates the prevalence and determinants of three main states of people's willingness to be vaccinated (WTBV) against COVID-19 – willing, unwilling and hesitant – and the occurrence and predictors of shifts between these states over time. Understanding the dynamics of vaccine intentions is crucial for developing targeted campaigns to increase uptake and emergency response preparedness. A panel survey consisting of 9 quarterly waves of data collected between April 2020 and January 2022. Baseline data included 24 952 adults from Germany, UK, Denmark, the Netherlands, France, Portugal, and Italy recruited from online panels to construct census-matched nationally representative samples. Self-reported COVID-19 vaccine intention was the main outcome. Multinomial logit random effects models were used to analyze the relationships of interest. All results reported as relative risk ratios (RRR). Hesitancy to get vaccinated was the most unstable vaccine intention, with on average 42% of ever hesitant respondents remaining in this state through future waves, followed by the 'unwilling' (53%) and 'willing (82%). Following COVID-19 news, trust in information from the government, GPs and the WHO, risk preferences, risk perceptions, and confidence in vaccines (or lack thereof) predicted vaccination intention reversals. Risk preferences acted both as an impediment and as a facilitator for the vaccine uptake depending on the initial vaccine intention. This study revealed the dynamic nature of COVID-19 vaccine intentions and its predictors in 7 European countries. The findings provide insights to policymakers for designing more effective communication strategies, particularly targeted at hesitant and unwilling to vaccinate population groups, to increase vaccine uptake for future public health emergencies. [ABSTRACT FROM AUTHOR]

• Many participants from GRT communities felt coerced into COVID-19 vaccinations. • Healthcare staff inadequately addressed or even dismissed vaccine concerns. • Vaccination decisions were affected by prior discrimination and barriers to care. • The standard 'vaccine hesitancy' model is of limited use in this situation. • Health services for GRT communities need to improve their overall trustworthiness. Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of "vaccine hesitancy". Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others' health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments. [ABSTRACT FROM AUTHOR]

In the wake of mass COVID-19 vaccination campaigns in 2021, significant differences in vaccine skepticism emerged across Europe, with Eastern European countries in particular facing very high levels of vaccine hesitancy and refusal. This study investigates the determinants of COVID-19 vaccine hesitancy and refusal, with a focus on these differences across Eastern, Southern and Western Europe. The statistical analyses are based on individual-level survey data comprising quota-based representative samples from 27 European countries from May 2021. The study finds that demographic variables have complex associations with vaccine hesitancy and refusal. The relationships with age and education are non-linear. Trust in different sources of health-related information has significant associations as well, with people who trust the Internet, social networks and 'people around' in particular being much more likely to express vaccine skepticism. Beliefs in the safety and effectiveness of vaccines have large predictive power. Importantly, this study shows that the associations of demographic, belief-related and other individual-level factors with vaccine hesitancy and refusal are context-specific. Yet, explanations of the differences in vaccine hesitancy across Eastern, Southern and Eastern Europe need to focus on why levels of trust and vaccine-relevant beliefs differ across regions, because the effects of these variables appear to be similar. It is the much higher prevalence of factors such as distrust of national governments and medical processionals as sources of relevant medical information in Eastern Europe that are relevant for explaining the higher levels of vaccine skepticism observed in that region. [ABSTRACT FROM AUTHOR]

Introduction: The SAGE Working Group on Vaccine Hesitancy developed a vaccine hesitancy measure, the Vaccine Hesitancy Scale (VHS). This scale has the potential to aid in the advancement of research and immunization policy but has not yet been psychometrically evaluated., Methods: Using a cross-sectional design, we collected self-reported survey data from a large national sample of Canadian parents from August to September 2016. An online questionnaire was completed in English or French. We used exploratory and confirmatory factor analysis to identify latent constructs underlying parents' responses to 10 VHS items (response scale 1-5, with higher scores indicating greater hesitancy). In addition to the VHS, measures included socio-demographics items, vaccine attitudes, parents' human papillomavirus (HPV) vaccine decision-making stage, and vaccine refusal., Results: A total of 3779 Canadian parents completed the survey in English (74.1%) or French (25.9%). Exploratory and confirmatory factor analysis revealed a two-factor structure best explained the data, consisting of 'lack of confidence' (M = 1.98, SD = 0.72) and 'risks' (M = 3.07, SD = 0.95). Significant Pearson correlations were found between the scales and related vaccine attitudes. ANOVA analyses found significant differences in the VHS sub-scales by parents' vaccine decision-making stages (p < .001). Independent samples t-tests found that the VHS sub-scales were associated with HPV vaccine refusal and refusing another vaccine (p < .001). Socio-demographic differences in the VHS were found; however, effect sizes were small (η 2  < 0.02)., Conclusions: The VHS was found to have two factors that have construct and criterion validity in identifying vaccine hesitant parents. A limitation of the VHS was few items that loaded on the 'risks' component and a lack of positively and negatively worded items for both components. Based on these results, we suggest modifying the wording of some items and adding items on risk perceptions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Vaccine hesitancy is a threat in combating vaccine-preventable diseases. It has been studied extensively in the Western countries but not so among Asian countries., Objectives: To assess the test-retest reliability of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire in Malay language; to determine the prevalence of vaccine hesitancy among parents and its associations with parents' socio-demographic characteristics., Methods: Forward and backward translation of PACV in Malay language was carried out. The reliability of the Malay-PACV questionnaire was tested among parents with children. The same questionnaire was used to study vaccine hesitancy among parents in a tertiary hospital in Kuala Lumpur. Information pertaining to socio-demographic characteristics, sources of information regarding vaccination and vaccine hesitancy were collected. Associations between vaccine hesitancy with socio-demographic factors were tested using Multivariable Logistic Regression., Results: The Spearman correlation coefficient and Cronbach alpha for total PACV was 0.79 (p<0.001) and 0.79 respectively. The intra-class correlation coefficients of the subscales ranged from 0.54 to 0.90 demonstrating fair to excellent reliability. A total of 63 (11.6%) parents were noted to be vaccine hesitant. In the univariate analyses, vaccine hesitancy was associated with unemployed parents, parents who were younger, had fewer children and non-Muslim. In the multivariate model, pregnant mothers expecting their first child were four times more likely to be vaccine hesitant compared to those who already had one or more children (aOR: 3.91, 95% CI: 1.74-8.79) and unemployed parents were also more likely to be vaccine hesitant (aOR: 1.97, 95% CI: 1.08-3.59). The internet (65.6%) was the main source of information on vaccination followed by brochures (56.9%)., Conclusion: The Malay-PACV questionnaire is reliable to be used. The prevalence of vaccine hesitancy among the multi-ethnic Malaysians was comparable with other populations. Pregnant mothers expecting their first child and unemployed parents were found to be more vaccine hesitant., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences., (Copyright © 2015. Published by Elsevier Ltd.)

Background: Vaccine hesitancy constitutes a major threat to the Global Polio Eradication Initiative (GPEI), and to further expansion of routine immunisation. Understanding hesitancy, leading in some cases to refusal, is vital to the success of GPEI. Re-emergence of circulating wild poliovirus in northern Nigeria in mid-2016, after 24months polio-free, gives urgency to this. But it is equally important to protect and sustain the global gains available through routine immunisation in a time of rising scepticism and potential rejection of specific vaccines or immunisation more generally., Methods and Findings: This study is based on a purposive sampling survey of 1653 households in high- and low-performing rural, semiurban and urban areas of three high-risk states of northern Nigeria in 2013-14 (Sokoto, Kano and Bauchi). The survey sought to understand factors at household and community level associated with propensity to refuse polio vaccine. Wealth, female education and knowledge of vaccines were associated with lower propensity to refuse oral polio vaccine (OPV) among rural households. But higher risk of refusal among wealthier, more literate urban household rendered these findings ambiguous. Ethnic and religious identity did not appear to be associated with risk of OPV refusal. Risk of vaccine refusal was highly clustered among households within a small sub-group of sampled settlements. Contrary to expectations, households in these settlements reported higher levels of expectation of government as service provider, but at the same time lesser confidence in the efficacy of their relations with government., Conclusions: Results suggest that strategies to address the micro-political dimension of vaccination - expanding community-level engagement, strengthening the role of local government in public health, and enhancing public participation of women - should be effective in reducing non-compliance, asan important set of strategies complementary to conventional didactic/educational approaches and working through religious and traditional 'influencers'., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

• The COVID-19 vaccine hesitancy scale (C19-VHS) has sound psychometric properties and is predictive of actual uptake of COVID-19 vaccination. • Higher hesitancy was observed among younger aged participants and female gender. • Older age, female gender, and getting the flu vaccine in the past year were predictive of COVID-19 vaccine uptake. The public's willingness to get vaccinated continues to be a source of concern. In this study we assessed the psychometric properties of the COVID-19 vaccine hesitancy scale (C19-VHS) as well as the association between the scale and self-reported past COVID-19 vaccination, approximately two weeks after the national vaccine distribution plan was launched in Israel. Participants were recruited via an online survey distributed through social media platforms and mailing lists. A total of 650 individuals completed the C19-VHS, the general vaccine hesitancy scale, and the fear of COVID-19 scale, and reported on demographic and pandemic-related characteristics. Principal component and Cronbach's alpha analyses were performed to assess the factor structure and reliability of the scale. Logistic regressions were employed to assess the scale's convergent and discriminative validity. Two factors pertaining to "lack of confidence" (Factor 1) and "risk perception" (Factor 2) emerged. Cronbach's alpha indicated good reliability of Factor 1 (0.93), with lower reliability of Factor 2 (0.72). Younger age was associated with higher risk perception, with women showing less confidence and perceiving greater risks. Lower hesitancy significantly predicted actual COVID-19 vaccine uptake after adjusting for demographic and pandemic-related factors (OR = 1.16, 95%CI 1.11–1.21, p <.001). Older age, being a woman, and receiving the flu vaccine in the past year were also predictive of COVID-19 vaccine uptake. The C19-VHS measure shows robust psychometric properties and is associated with actual vaccine uptake. Future studies assessing COVID-19 vaccination attitudes may utilize this scale to assess current COVID-19 vaccine hesitancy in different contexts and cultures. [ABSTRACT FROM AUTHOR]

• Ways of coping with the threat of COVID-19 predicted subsequent vaccine hesitancy. • Avoidance coping was associated with subsequent vaccine hesitancy. • Low perception of COVID-19 threat was associated with subsequent vaccine hesitancy. • Approach coping reduced vaccine hesitancy among those perceiving low COVID-19 threat. • Coping responses may serve as targets for intervention to reduce vaccine hesitancy. The COVID-19 pandemic has brought to light the importance of identifying factors associated with vaccine hesitancy. Disease threat and coping responses are central to health behavior engagement and present potential alterable targets for intervention. To examine the roles of perceived threat of COVID-19 and coping in vaccine hesitancy, we examined how coping strategies involving approach and avoidance interact with perceived threat of COVID-19 to predict vaccine hesitancy. We used data from 1570 North American participants who reported their vaccine hesitancy as part of a longitudinal study assessing psychosocial responses to the pandemic. We used logistic regression models and mean scores of perceived threat of COVID-19, approach coping, and avoidance coping from prior timepoints to predict vaccine hesitancy in December 2020, when COVID-19 vaccines were first being approved for use in North America. Low perceived threat of COVID-19 was associated with greater likelihood of being vaccine hesitant. However, approach coping moderated this association, such that people who engaged in more approach coping were less likely to be vaccine hesitant even when they did not feel personally threatened by COVID-19. In contrast, avoidance coping was associated with greater likelihood of vaccine hesitancy regardless of perceived threat of COVID-19. Our results illustrate the contributions of approach and avoidance coping to vaccine hesitancy and in doing so, provide preliminary evidence for coping behavior to serve as a target for intervention to reduce vaccine hesitancy. [ABSTRACT FROM AUTHOR]

While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations., (Copyright © 2016. Published by Elsevier Ltd.)

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants' beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients., (Copyright © 2016. Published by Elsevier Ltd.)

Objective: To describe vaccine attitudes among pediatric healthcare providers attending immunization conferences., Study Design: Attendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson's chi-square tests and Fisher's exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics., Results: 680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant., Conclusion: Vaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

• Vaccine hesitant parents tend to see vaccine hesitant providers. • Provider vaccine hesitancy is associated with children's higher odds of non-timely vaccination. • Parental vaccine hesitancy is associated with children's higher odds of non-timely vaccination. • A higher the degree of parental and provider vaccine hesitancy is associated with increased odds of non-timely vaccination. Although medical providers are a trusted vaccination information source for parents, they do not universally support vaccination. Complementary medicine (CM) providers are particularly likely to hold vaccine hesitant (VH) views, and VH parents often consult with them. Little research compares VH of parents and providers, and if and how each is associated with uptake of recommended childhood vaccines. We defined non-timely receipt as recommended vaccines given > 1 month later than officially recommended, based on vaccination records. We administered versions of the Parent Attitudes about Childhood Vaccines (PACV) 5-item survey instrument to 1256 parents and their children's pediatricians (N = 112, 40 CM-oriented, 72 biomedical [not CM-oriented]) to identify moderately (PACV-score 5–6) and highly (PACV-score 7+) hesitant providers/parents. We obtained multivariable adjusted odds ratios to test relationships between parental VH and provider type/VH, and between non-timely receipt of selected childhood vaccines and parental VH and provider type/VH. No biomedical providers were VH, 9 CM providers were moderately VH, and 17 were highly VH. Parents seeing moderately and highly hesitant providers had adjusted odds ratio (AOR) for being VH = 6.6 (95% confidence interval (CI), 3.1–14.0) and AOR = 31.3 (95% CI 16.8–58.3), respectively. Across all vaccine uptake endpoints, children of moderately and highly hesitant parents had 1.9–3.8 and 7.1–12.3 higher odds of non-timely vaccination, and children seeing highly hesitant CM providers had 4.9–9.4 higher odds. Children seeing moderately hesitant CM providers had 3.3 higher odds of non-timely vaccination for the 1st dose of measles and 3.5 higher odds for 1st dose of polio/pertussis/tetanus. VH by both parents and providers each is associated with non-timely childhood vaccination. As VH parents are more likely to consult with VH providers, interventions aimed at increasing timely vaccination need to primarily target VH providers and their clients. [ABSTRACT FROM AUTHOR]

To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout. We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications. Both supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time. Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages. [ABSTRACT FROM AUTHOR]

• Vaccine hesitancy and COVID-19 pandemic threaten immunization coverage. • Educational videos intervention may lower vaccine hesitancy. • Videos can be used as health education tools in the community. As one of the essential programs that have been developed for decades, childhood immunizations are mandatory to protect children from vaccine-preventable diseases. Despite its availability and accessibility, immunization coverage has not reached the intended goals. Vaccine hesitancy and COVID-19 pandemic may threaten immunization coverage in children. This study aimed to evaluate the tailored educational videos to reduce vaccine hesitancy and analyze the changes in childhood routine immunization status. This was an interventional quasi-experimental study in three subdistricts of North Jakarta, Indonesia. Participants were allocated into educational videos exposures (intervention group, n = 116) or to the digital version of the maternal and child health handbook (control group, n = 104). We administered a pre- and post-intervention vaccine hesitancy survey using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire with cut-off scores of 50. A total of 220 parents were recruited in this study from June 18, 2021, to December 10, 2021. The pre-intervention PACV survey showed that 19 (8.6%) parents were vaccine-hesitant from both groups: 12 (10.3%) and 7 (6.7%) of parents among intervention and control groups. After the interventions, there were 8 (6.9%) and 8 (7.7%) vaccine-hesitant parents in the intervention and control groups, respectively. We found a significant difference in the post-intervention PACV median score between the intervention and control groups (17 vs 23; p = 0.035). Around 25% of parents have not completed their children's immunization status: 22.4% and 28.8% in the intervention and control groups, respectively. There was a significant difference between the proportion of PACV hesitancy on the immunization status within intervention and control groups (p = 0.001). There was a reduction in vaccine hesitancy after interventions. Educational videos intervention distributed through WhatsApp group was associated with lower vaccine hesitancy and can be used as health education tools among Indonesian parents in the community. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy affects immunization programs worldwide and can impact vaccine coverage and fight against Coronavirus disease 2019 (COVID-19) too. Primary objectives: To find out the magnitude of COVID-19 vaccine hesitancy among the Health Care Worker Parents (HCWPs), the reasons for vaccine hesitancy, and their perceptions regarding COVID-19 vaccination of their children. Secondary objective: To analyze the clinic-socio-demographic correlates of COVID-19 vaccine hesitancy among HCWPs. This was a cross sectional descriptive study. Health care workers who are parents were invited to participate in the study. Details about COVID vaccination status, COVID-19 illness of HCWPS and family members and its outcomes , reasons for not getting vaccinated, willingness to vaccinate their children, reasons for not willing to vaccinate their children, their responses to vaccine hesitancy survey (VHS) questionnaire and Modified Oxford COVID-19 vaccine hesitancy scale (MOVHS) were collected and analyzed using descriptive statistics. A total of 269 HCWPs participated in the study. Of the HCWPs, 97% had completed their COVID-19 vaccination schedule. Majority stated that they would vaccinate their children when it is available. Although majority of the responses were positive or towards agreement, there were some striking variations in the responses among some sections of HCWPs. Positive responses to the questionnaire were associated with higher self-vaccination and a decision to vaccinate their children. Vaccine hesitancy was less common among HCWPs in our study. A section of the HCWPs might be disproportionately more hesitant than others. Majority were in favor of vaccinating their children. [ABSTRACT FROM AUTHOR]

Background: Addressing parental vaccine hesitancy may increase adolescent vaccination acceptance. However, no validated measure exists to identify parents hesitant toward adolescent vaccines., Objective: To determine if a modified version of the Parent Attitudes about Childhood Vaccines (PACV) survey, a previously validated tool to identify parental hesitancy toward vaccines in infants, predicts adolescent vaccine uptake at office visits., Methods: We modified the PACV for use in the adolescent setting and distributed it to a convenience sample of parents of adolescents aged 11 to 17 presenting for care at a diverse group of six pediatric practices in Oklahoma and South Carolina. We determined the vaccination status of the parents' adolescents for 3 vaccines (Tetanus-diphtheria-acellular pertussis [Tdap], meningococcal conjugate [MCV4], and human papillomavirus [HPV] vaccines). We used Fisher's exact tests to compare vaccination status with each survey item and with an overall general hesitancy scale that we constructed., Results: We analyzed 363 surveys. At the time of the visit, vaccination coverage was 84% for Tdap, 73% for MCV, and 45% for any dose of HPV. Thirty-nine percent of parents expressed concern about vaccine efficacy and 41% expressed concern about side effects. Forty-five percent of parents disagreed with the statement that "teens can get all of the vaccines that are due at a single visit." Two individual items were associated with not receiving a dose of HPV vaccine that was due. The overall modified PACV score failed to predict adolescent vaccine uptake at an office visit., Conclusion: Several individual items were associated with vaccine uptake. The cumulative modified PACV, a general measure of vaccine hesitancy, was not associated with vaccination status despite illuminating parental hesitancy. We need to better understand vaccine-specific concerns for the adolescent population., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

To verify the reliability and validity of a vaccine hesitancy scale about knowledge, attitude, trust and vaccination environment (KATE-S) among the Chinese parents. A questionnaire survey was conducted by convenience sampling in China using the KATE-S to assess knowledge of vaccines, attitudes towards vaccines, trust in acquired information and vaccination environment and vaccination status of vaccine introduced in immunization program among children. A total of 199 valid questionnaires were collected from the parents. Among those, 83 (41.7%) parents accepted all vaccines without hesitancy, 111 (55.8%) parents accepted all but had hesitancy intention, and 5 (2.5%) had hesitancy behaviour of refusing or delaying vaccination. The overall test–retest reliability, split-half reliability and Cronbach's coefficient values were 0.924, 0.885 and 0.823, respectively. The scale-level content validity index (S-CVI) of universal agreement was 0.867, and the average S-CVI was 0.978. Exploratory factor analysis extracted seven common factors from the scale, and the cumulative contribution rate was 56.8%. The correlation coefficients between the items and their dimensions ranged from 0.405 to 0.760, with a calibration success rate of 100% for convergent and discriminant validity. After adjusting for the basic characteristics, the knowledge level of hesitancy intention group and hesitancy behavior group were both lower than accept all group (OR = 0.78, 95% CI: 0.65–0.94; OR = 0.26, 95 %CI: 0.07–0.94). The KATE-S has good reliability and validity in Chinese parents and would be considered to expand the sample size and survey areas to obtain more representative results. [ABSTRACT FROM AUTHOR]